Provider Demographics
NPI:1922569847
Name:SACHIN PRAKASH, UNKNOWN (CDPT NCPT)
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:
Last Name:SACHIN PRAKASH
Suffix:
Gender:M
Credentials:CDPT NCPT
Other - Prefix:
Other - First Name:SACHIN
Other - Middle Name:
Other - Last Name:PRAKASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDPT NCPT
Mailing Address - Street 1:5321 LAKEMONT BLVD SE APT 1213
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6620
Mailing Address - Country:US
Mailing Address - Phone:832-998-5052
Mailing Address - Fax:
Practice Address - Street 1:16715 AURORA AVE N # 102
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5310
Practice Address - Country:US
Practice Address - Phone:206-546-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60760445101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)