Provider Demographics
NPI:1649457888
Name:JOSEPHSON, DAVID ALAN (MS, ACADC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:MS, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-0761
Mailing Address - Country:US
Mailing Address - Phone:208-791-4925
Mailing Address - Fax:509-758-1028
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2141
Practice Address - Country:US
Practice Address - Phone:208-791-4925
Practice Address - Fax:509-758-1028
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID45-100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)