Provider Demographics
NPI:1467709444
Name:DONOVAN-DUPONT, ANDREA CHRISTINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:DONOVAN-DUPONT
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 1:415 222ND ST SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9724
Mailing Address - Country:US
Mailing Address - Phone:425-483-9010
Mailing Address - Fax:
Practice Address - Street 1:4515 MARTIN LUTHER KING JR WAY S STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2183
Practice Address - Country:US
Practice Address - Phone:206-320-5325
Practice Address - Fax:206-760-6339
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60249248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker