Provider Demographics
NPI:1811056674
Name:DUBOIS, MICHELLE LEE (LMHC,CDP,MAC,NAADAC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LEE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:LMHC,CDP,MAC,NAADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 GARFIELD ST S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-3825
Mailing Address - Country:US
Mailing Address - Phone:253-330-2901
Mailing Address - Fax:
Practice Address - Street 1:1516 S 11TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3332
Practice Address - Country:US
Practice Address - Phone:253-396-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005533101YA0400X
WALH00004887101YM0800X
VA85353 MAC,NAADAC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional