Provider Demographics
NPI:1467206482
Name:INFELISE, ANITA RAE (SUDP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:RAE
Last Name:INFELISE
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1552
Mailing Address - Country:US
Mailing Address - Phone:425-501-9876
Mailing Address - Fax:
Practice Address - Street 1:526 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3626
Practice Address - Country:US
Practice Address - Phone:425-501-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)