Provider Demographics
NPI:1700160702
Name:SEATTLE SOCIAL SKILLS SUPPORT LLC
Entity Type:Organization
Organization Name:SEATTLE SOCIAL SKILLS SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-227-6294
Mailing Address - Street 1:4026 NE 55TH ST STE D175
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2254
Mailing Address - Country:US
Mailing Address - Phone:206-227-6294
Mailing Address - Fax:206-366-9630
Practice Address - Street 1:4026 NE 55TH ST STE D175
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2254
Practice Address - Country:US
Practice Address - Phone:206-227-6294
Practice Address - Fax:206-366-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-08
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty