Provider Demographics
NPI:1285395103
Name:SUAREZ, MARJORIE MAE (CDPTCO61129031)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MAE
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:CDPTCO61129031
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3393
Mailing Address - Country:US
Mailing Address - Phone:509-792-1041
Mailing Address - Fax:
Practice Address - Street 1:1906 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3393
Practice Address - Country:US
Practice Address - Phone:509-792-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACDPT.CO.61129031207QA0401X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine