Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 101YAO400X | WA |
NPI | 1003130535 |
---|---|
Provider Name | Mr. David Merritt Hicks |
First Address | Seattle, WA 98118-0442 |
Second Address | Everett, WA 98201-2927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2010 |
Last Update Date | 26/03/2010 |