Provider Demographics
NPI:1740780675
Name:GROCE, CASSANDRA LYNN (CDPT)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LYNN
Last Name:GROCE
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5416
Mailing Address - Country:US
Mailing Address - Phone:253-502-5444
Mailing Address - Fax:
Practice Address - Street 1:510 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5416
Practice Address - Country:US
Practice Address - Phone:253-572-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60717187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60717187OtherCHEMICAL DEPENDENCY PROFESSIONAL TRAINEE CERTIFICATION