Provider Demographics
NPI:1285106427
Name:ROBERTSON, DREW LORING (CDP)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:LORING
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 IRVING ST SW STE 301
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6362
Mailing Address - Country:US
Mailing Address - Phone:509-232-5766
Mailing Address - Fax:509-242-1867
Practice Address - Street 1:12715 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1027
Practice Address - Country:US
Practice Address - Phone:509-232-5766
Practice Address - Fax:509-321-5472
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid