Provider Demographics
NPI:1053441980
Name:SANCHEZ, MARCO (MA MHP, CDP DVC)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MA MHP, CDP DVC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13527 DENSMORE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7738
Mailing Address - Country:US
Mailing Address - Phone:206-478-1191
Mailing Address - Fax:206-522-3920
Practice Address - Street 1:1833 N 105TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8973
Practice Address - Country:US
Practice Address - Phone:206-478-1191
Practice Address - Fax:206-522-3920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17693103TC0700X
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)