Provider Demographics
NPI:1033688288
Name:FLETCHER, ROBERTA L (CDP)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:L
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2007
Mailing Address - Country:US
Mailing Address - Phone:206-834-4029
Mailing Address - Fax:206-834-4091
Practice Address - Street 1:611 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2007
Practice Address - Country:US
Practice Address - Phone:206-834-4029
Practice Address - Fax:206-834-4091
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)