Provider Demographics
NPI:1346787918
Name:DULL, SAMANTHA LOUISE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LOUISE
Last Name:DULL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 GRANT AVE S
Mailing Address - Street 2:H101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 GRANT AVE S
Practice Address - Street 2:H101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-3061
Practice Address - Country:US
Practice Address - Phone:650-996-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health