Provider Demographics
NPI:1093267593
Name:MORALES, DOMITILA
Entity type:Individual
Prefix:
First Name:DOMITILA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 W MELVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-1941
Mailing Address - Country:US
Mailing Address - Phone:509-905-7098
Mailing Address - Fax:509-581-6134
Practice Address - Street 1:819 S. AUBURN ST.
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-905-7098
Practice Address - Fax:509-581-6134
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
101Y00000X
WALW615055601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171R00000XOther Service ProvidersInterpreter
No101Y00000XBehavioral Health & Social Service ProvidersCounselor