=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871305086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA G HUNT SUDPT CO 61642966
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 893 SE PIONEER WAY
-----------------------------------------------------
City | OAK HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98277-5729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-659-5620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27337 STATE ROUTE 20
-----------------------------------------------------
City | OAK HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98277-8307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-929-5742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CO61642966
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------