Provider Demographics
NPI:1497028823
Name:EPHRAIM, JC
Entity Type:Individual
Prefix:
First Name:JC
Middle Name:
Last Name:EPHRAIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 E UNION ST
Mailing Address - Street 2:207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2966
Mailing Address - Country:US
Mailing Address - Phone:206-726-0430
Mailing Address - Fax:206-726-0439
Practice Address - Street 1:2314 E UNION ST
Practice Address - Street 2:207
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2966
Practice Address - Country:US
Practice Address - Phone:206-726-0430
Practice Address - Fax:206-726-0439
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001663101YA0400X
WAMC60151428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)