Provider Demographics
NPI:1023563475
Name:HANSONEPSTEIN, DJ (CDP)
Entity Type:Individual
Prefix:MR
First Name:DJ
Middle Name:
Last Name:HANSONEPSTEIN
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDP
Mailing Address - Street 1:1616 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4648
Mailing Address - Country:US
Mailing Address - Phone:360-676-6177
Mailing Address - Fax:
Practice Address - Street 1:1616 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4648
Practice Address - Country:US
Practice Address - Phone:360-676-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006351101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)