Healthcare Provider Details

I. General information

NPI: 1558846618
Provider Name (Legal Business Name): DIANE ELIZABETH HOPKINS LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20110 VASHON HWY SW
VASHON WA
98070-6026
US

IV. Provider business mailing address

PO BOX 2272
VASHON WA
98070-2272
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-5511
  • Fax: 206-463-5513
Mailing address:
  • Phone: 509-218-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSC60671894
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60010883
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60671894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: