Provider Demographics
NPI:1114179041
Name:D ADDARIO, JUSTUS CESIDIO (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JUSTUS
Middle Name:CESIDIO
Last Name:D ADDARIO
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WELLS AVE S
Mailing Address - Street 2:UNIT A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2785
Mailing Address - Country:US
Mailing Address - Phone:206-877-3188
Mailing Address - Fax:206-400-1142
Practice Address - Street 1:306 WELLS AVE S
Practice Address - Street 2:UNIT A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2785
Practice Address - Country:US
Practice Address - Phone:206-877-3188
Practice Address - Fax:206-400-1142
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60196750101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor