Individual
THEA ANN SCOGGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAC III
Contact information
Practice address
811 MADISON ST, EVERETT, WA 98203
(425) 212-4200
Mailing address
PO BOX 2569, EVERETT, WA 98213-0569
(425) 212-4200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC.0006562
CO
Other
Enumeration date
12/06/2012
Last updated
05/17/2018
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