Provider Demographics
NPI:1306321682
Name:DULL, ARLEEN DALE I (CP 0002019)
Entity type:Individual
Prefix:
First Name:ARLEEN
Middle Name:DALE
Last Name:DULL
Suffix:I
Gender:F
Credentials:CP 0002019
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1700
Mailing Address - Country:US
Mailing Address - Phone:509-697-5486
Mailing Address - Fax:
Practice Address - Street 1:1501 CEDAR LN
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1700
Practice Address - Country:US
Practice Address - Phone:509-697-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP0002019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty