Provider Demographics
NPI:1104431030
Name:DALIS LA GROTTA COUNSELING PLLC
Entity type:Organization
Organization Name:DALIS LA GROTTA COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LA GROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:206-854-4122
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324-0893
Mailing Address - Country:US
Mailing Address - Phone:206-854-4122
Mailing Address - Fax:
Practice Address - Street 1:435 W BELL ST STE D
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-2916
Practice Address - Country:US
Practice Address - Phone:360-797-1429
Practice Address - Fax:360-477-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty