Provider Demographics
NPI:1013363886
Name:GOODING, STEVEN BRUCE (CDP)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BRUCE
Last Name:GOODING
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:SWINOMISH INDIAN TRIBAL COMMUNITY CHEMICAL DEPENDENCY
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257
Mailing Address - Country:US
Mailing Address - Phone:360-848-8437
Mailing Address - Fax:360-848-5250
Practice Address - Street 1:17400 RESERVATION RD.
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257
Practice Address - Country:US
Practice Address - Phone:360-588-2730
Practice Address - Fax:360-848-5250
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60617801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)