Provider Demographics
NPI:1255989117
Name:ROTTA, DONETTE LYN (LMHC)
Entity type:Individual
Prefix:
First Name:DONETTE
Middle Name:LYN
Last Name:ROTTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 SEAHURST AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203
Mailing Address - Country:US
Mailing Address - Phone:206-353-4362
Mailing Address - Fax:
Practice Address - Street 1:6300 STORKSON RD # B2
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9514
Practice Address - Country:US
Practice Address - Phone:425-788-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty