Healthcare Provider Details

I. General information

NPI: 1215294715
Provider Name (Legal Business Name): ALISA MARIE HUFFMAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 06/24/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELLIOTT AVE W STE 500
SEATTLE WA
98119-4292
US

IV. Provider business mailing address

522 W RIVERSIDE AVE # 8144
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-6175
  • Fax:
Mailing address:
  • Phone: 253-237-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60621424
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW 60621424
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC 60343773
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC 60343773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: