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General NPI Number Information
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NPI Number | 1033548805
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Entity Type | Organization
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Legal Business Name | DECIDE DIFFERENTLY, LLC
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 271 MADISON AVE S STE 203
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-2524
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Country | US
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Telephone | 206-486-4338
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4467
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City | ROLLINGBAY
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State | WA
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Zip | 98061-0467
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Country | US
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Telephone | 206-486-4338
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPSIT
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Name | MS. SHAKTI SUTRIASA
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Credential | LCSW
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Telephone | 206-486-4338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 11579
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License Number State | FL
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