Provider Demographics
NPI:1255812699
Name:SALAMANCA, MICHELLE A (CDPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:SALAMANCA
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 94TH ST SW APT 23C
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3742
Mailing Address - Country:US
Mailing Address - Phone:505-303-0179
Mailing Address - Fax:
Practice Address - Street 1:10315 19TH AVE SE STE 112
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4268
Practice Address - Country:US
Practice Address - Phone:206-362-7282
Practice Address - Fax:206-362-7152
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60614515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)