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Individual

JEROME DOHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CDP

Contact information

Practice address
11000 LAKE CITY WAY NE, SEATTLE, WA 98125-6748
(206) 632-5009
Mailing address
11000 LAKE CITY WAY NE, SEATTLE, WA 98125-6748
(206) 632-5009

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1006
WA

Other

Enumeration date
08/02/2016
Last updated
08/02/2016
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