Healthcare Provider Details

I. General information

NPI: 1669386454
Provider Name (Legal Business Name): DOUGLAS REVELLE CARNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 E TRENT AVE
SPOKANE WA
99212-1315
US

IV. Provider business mailing address

1655 E QUEEN AVE
SPOKANE WA
99207-4145
US

V. Phone/Fax

Practice location:
  • Phone: 509-424-5277
  • Fax: 509-795-3141
Mailing address:
  • Phone: 509-309-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number70142850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: