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NPI Code Detail

MEDICARE: DIONNE E KING SUDPT

MEDICARE: DIONNE E KING SUDPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1609539246
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIONNE E KING SUDPT
Provider Business Mailing Address
First Line : 3051 W SIMS WAY
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2255
Country : US
Telephone Number : 360-385-1258
Fax Number :
Provider Business Practice Location Address
First Line : 3051 W SIMS WAY
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2255
Country : US
Telephone Number : 360-385-1258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2021
Last Update Date : 10/20/2021

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Directions to “ DIONNE E KING SUDPT” Practice Location

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