Provider Demographics
NPI:1790041507
Name:FLACK, DAVID (LMHC, SUDP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FLACK
Suffix:
Gender:M
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15458 21ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-5801
Mailing Address - Country:US
Mailing Address - Phone:206-327-4478
Mailing Address - Fax:
Practice Address - Street 1:15458 21ST AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-9816
Practice Address - Country:US
Practice Address - Phone:206-327-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006223101YA0400X
WALH60548722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)