Healthcare Provider Details

I. General information

NPI: 1861349839
Provider Name (Legal Business Name): DEVONTE K MCRAE SUDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 S J ST
TACOMA WA
98405-4110
US

IV. Provider business mailing address

1308 12TH AVE NW
PUYALLUP WA
98371-4004
US

V. Phone/Fax

Practice location:
  • Phone: 253-300-2848
  • Fax:
Mailing address:
  • Phone: 762-207-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70120388
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: