Provider Demographics
NPI:1669745543
Name:DUBOSE, ACIE S (MPSY)
Entity type:Individual
Prefix:MR
First Name:ACIE
Middle Name:S
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 23RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5308
Mailing Address - Country:US
Mailing Address - Phone:206-229-1118
Mailing Address - Fax:206-329-7033
Practice Address - Street 1:2715 23RD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5308
Practice Address - Country:US
Practice Address - Phone:206-229-1118
Practice Address - Fax:206-329-7033
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60163955101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor