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General NPI Number Information
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NPI Number | 1154117406
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE HUGHES SUDPT
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1720 S GOLD ST
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City | CENTRALIA
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State | WA
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Zip | 98531-8951
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Country | US
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Telephone | 360-261-6930
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 CORY CT SE
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City | LACEY
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State | WA
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Zip | 98513-4111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CO61400932
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License Number State | WA
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