Provider Demographics
NPI:1154938041
Name:LAROCQUE, JOSEPH J (SUDP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:LAROCQUE
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 W GARDNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1743
Mailing Address - Country:US
Mailing Address - Phone:509-850-1354
Mailing Address - Fax:
Practice Address - Street 1:3710 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2850
Practice Address - Country:US
Practice Address - Phone:509-328-5234
Practice Address - Fax:509-328-2358
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61334705101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2204287Medicaid
WA2077844Medicaid