Doctor Name: | DAVID FLACK |
NPI Number: | 1790041507 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CDP |
License Number: | CP00006223 |
Business Practice Address: | 26420 Ne Virginia St Ste 2 Duvall, WA - 980195801 |
Business Phone Number: | 4258449669 |
Business Fax Number: | |
Mailing Address: | 26420 Ne Virginia St Ste 2, DUVALL |
State: | WA |
Postal Code: | 980195801 |
Phone Number: | 4258449669 |
Fax Number: | |
NPI Enumeration Date: | 04/05/2012 |
NPI Last Update Date: | 04/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CP00006223 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |