Provider Demographics
NPI:1609323187
Name:WADKINS, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:WADKINS
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 1:219 1ST AVE S STE 310
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2551
Mailing Address - Country:US
Mailing Address - Phone:206-604-4211
Mailing Address - Fax:
Practice Address - Street 1:219 1ST AVE S STE 310
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2551
Practice Address - Country:US
Practice Address - Phone:206-604-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60670035101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor