Provider Demographics
NPI:1437376290
Name:DE VITIS, ROBERTA J (LMHC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:DE VITIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14041 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3411
Mailing Address - Country:US
Mailing Address - Phone:206-412-8943
Mailing Address - Fax:206-542-5235
Practice Address - Street 1:727 N 182ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4402
Practice Address - Country:US
Practice Address - Phone:206-412-8943
Practice Address - Fax:206-542-5235
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003452101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor