Provider Demographics
NPI:1215577721
Name:DELOACH, NARUSSIA BIANCA (MSW)
Entity Type:Individual
Prefix:
First Name:NARUSSIA
Middle Name:BIANCA
Last Name:DELOACH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 14TH AVE W APT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2446
Mailing Address - Country:US
Mailing Address - Phone:225-501-4858
Mailing Address - Fax:
Practice Address - Street 1:2243 14TH AVE W APT C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2446
Practice Address - Country:US
Practice Address - Phone:225-938-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WASC61254176104100000X
WALW614438481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG61048510Medicaid
WASA61042901Medicaid