Provider Demographics
NPI:1811282379
Name:GUBATAYAO, JOHN DIONISIO (CDP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DIONISIO
Last Name:GUBATAYAO
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 LAKE CITY WAY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:10001 17TH PL S
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1615
Practice Address - Country:US
Practice Address - Phone:206-766-6976
Practice Address - Fax:206-766-6993
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)