Provider Demographics
NPI:1598426306
Name:DOGGETT, JINA
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:
Last Name:DOGGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 E SPRAGUE AVE STE D4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6122
Mailing Address - Country:US
Mailing Address - Phone:509-927-6838
Mailing Address - Fax:
Practice Address - Street 1:11711 E SPRAGUE AVE STE D4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6122
Practice Address - Country:US
Practice Address - Phone:509-927-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006370101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
85-1372514OtherBEHAVIORAL HEALTH