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General NPI Number Information
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NPI Number | 1437376290
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Entity Type | Individual
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Provider Name | ROBERTA J DE VITIS LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 727 N 182ND ST SUITE 202
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City | SHORELINE
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State | WA
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Zip | 98133-4402
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Country | US
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Telephone | 206-412-8943
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Fax | 206-542-5235
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Provider Business Mailing Address
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Address Line | 14041 25TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98125-3411
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Country | US
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Telephone | 206-412-8943
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Fax | 206-542-5235
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LH00003452
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License Number State | WA
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