Provider Demographics
NPI:1093267593
Name:MORALES, DOMITILA
Entity Type:Individual
Prefix:
First Name:DOMITILA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2746
Mailing Address - Country:US
Mailing Address - Phone:509-946-4645
Mailing Address - Fax:509-946-1398
Practice Address - Street 1:2139 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354
Practice Address - Country:US
Practice Address - Phone:509-946-4645
Practice Address - Fax:509-946-1398
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171R00000XOther Service ProvidersInterpreter