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General NPI Number Information
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NPI Number | 1417772377
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Entity Type | Organization
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Legal Business Name | ROAD TO HEALING PSYCHIATRIC LLC
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Dates
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Enumeration Date | 11/16/2024
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 600 1ST AVE SUITE 102 #2096
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City | SEATTLE
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State | WA
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Zip | 98104
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Country | US
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Telephone | 281-846-5587
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Fax |
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Provider Business Mailing Address
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Address Line | 600 1ST AVE SUITE 102 #2096
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City | SEATTLE
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State | WA
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Zip | 98104
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Country | US
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Telephone | 281-846-5587
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Fax |
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Authorized Official
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Title or Position | CEO/ CLINICAL DIRECTOR
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Name | ANIEKAN UDOH
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Credential |
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Telephone | 281-846-5587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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