Provider Demographics
NPI:1942443304
Name:WEEKLEY, JEANA (CDP)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:WEEKLEY
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 120TH AVE NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2135
Mailing Address - Country:US
Mailing Address - Phone:425-283-4200
Mailing Address - Fax:425-679-5679
Practice Address - Street 1:1215 120TH AVE NE
Practice Address - Street 2:SUITE 204
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2135
Practice Address - Country:US
Practice Address - Phone:425-283-4200
Practice Address - Fax:425-679-5679
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006242101YA0400X
WARC0004507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health