Provider Demographics
NPI:1053500280
Name:NUMKENA, NORA DOREEN (MSW, LMHC, CDP)
Entity Type:Individual
Prefix:MS
First Name:NORA
Middle Name:DOREEN
Last Name:NUMKENA
Suffix:
Gender:F
Credentials:MSW, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:116 NORTH MAIN ST
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-2294
Mailing Address - Country:US
Mailing Address - Phone:509-939-7720
Mailing Address - Fax:509-276-2774
Practice Address - Street 1:1803 W MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2831
Practice Address - Country:US
Practice Address - Phone:509-325-5502
Practice Address - Fax:509-325-9839
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004093101YA0400X
WALH00009315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602766698OtherUBI NUMBER