Provider Demographics
NPI:1467944025
Name:POPPE, DOROTHY DARLENE (CDPT)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:DARLENE
Last Name:POPPE
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9227 N LEHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9594
Mailing Address - Country:US
Mailing Address - Phone:509-953-0959
Mailing Address - Fax:
Practice Address - Street 1:610 E NORTH FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2160
Practice Address - Country:US
Practice Address - Phone:509-487-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60560362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2095649Medicaid
WACO60560362OtherCHEMICAL DEPENDENCY PROFESSIONAL TRAINEE