Provider Demographics
NPI:1598285470
Name:GAUTAM ACHARYA, DIPA (CM)
Entity Type:Individual
Prefix:
First Name:DIPA
Middle Name:
Last Name:GAUTAM ACHARYA
Suffix:
Gender:F
Credentials:CM
Other - Prefix:MRS
Other - First Name:DIPA
Other - Middle Name:
Other - Last Name:GAUTAM ACHARYA
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:3639 MLK JR WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6847
Mailing Address - Country:US
Mailing Address - Phone:207-695-7600
Mailing Address - Fax:
Practice Address - Street 1:3639 MLIK JR.WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-695-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60131173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor