Healthcare Provider Details

I. General information

NPI: 1023665650
Provider Name (Legal Business Name): DUSTIN EUGENE KING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 3RD AVE
SPOKANE WA
99202-6014
US

IV. Provider business mailing address

701 E 3RD AVE
SPOKANE WA
99202-6014
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-6092
  • Fax:
Mailing address:
  • Phone: 509-838-6092
  • Fax: 509-838-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61411222
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61290981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: