Individual
ETHAN MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
4540 SAND POINT WAY NE STE 200, SEATTLE, WA 98105-3941
(206) 987-2000
Mailing address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(206) 987-2000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6801094378
MI
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
LW60626693
WA
1041C0700X
Clinical Social Worker
LW60626693
WA
Other
Enumeration date
06/02/2014
Last updated
01/28/2022
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