Provider Demographics
NPI:1124368311
Name:CULPEPPER, D'GHON ANTOINE SR (LMP)
Entity Type:Individual
Prefix:MR
First Name:D'GHON
Middle Name:ANTOINE
Last Name:CULPEPPER
Suffix:SR
Gender:M
Credentials:LMP
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 820664
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0015
Mailing Address - Country:US
Mailing Address - Phone:503-896-0473
Mailing Address - Fax:
Practice Address - Street 1:10273 NE NOTCHLOG DR
Practice Address - Street 2:APT 208
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-5406
Practice Address - Country:US
Practice Address - Phone:503-896-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60313132225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist