Provider Demographics
NPI:1487736757
Name:ALBERSON, DENNIS EVERETT (LCSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EVERETT
Last Name:ALBERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 NE 258TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9754
Mailing Address - Country:US
Mailing Address - Phone:360-666-0470
Mailing Address - Fax:360-666-5057
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8508
Practice Address - Country:US
Practice Address - Phone:360-666-0470
Practice Address - Fax:360-666-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR#22441041C0700X
WALW000060701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G115001160Medicare ID - Type Unspecified