Provider Demographics
NPI:1467965103
Name:HUTSON-DE NOVELLIS, ROMINA (CDP)
Entity Type:Individual
Prefix:MRS
First Name:ROMINA
Middle Name:
Last Name:HUTSON-DE NOVELLIS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LAKEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5233
Mailing Address - Country:US
Mailing Address - Phone:360-676-2187
Mailing Address - Fax:
Practice Address - Street 1:515 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5233
Practice Address - Country:US
Practice Address - Phone:844-358-5033
Practice Address - Fax:360-676-2162
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60732537101YA0400X
WACP60988555101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)