Provider Demographics
NPI:1972700102
Name:MCGLOTHLIN, DEANA RAE (CDP)
Entity Type:Individual
Prefix:MS
First Name:DEANA
Middle Name:RAE
Last Name:MCGLOTHLIN
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 1:1614 S FRUITLAND ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4841
Mailing Address - Country:US
Mailing Address - Phone:509-585-0874
Mailing Address - Fax:
Practice Address - Street 1:1614 S FRUITLAND ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-4841
Practice Address - Country:US
Practice Address - Phone:509-585-0874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001020101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)