Provider Demographics
NPI:1316504558
Name:HITCH, SHERRY ANGELEA (CDPT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANGELEA
Last Name:HITCH
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GRIEL RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-9639
Mailing Address - Country:US
Mailing Address - Phone:360-669-9708
Mailing Address - Fax:
Practice Address - Street 1:151 NE HAMPE WAY
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2403
Practice Address - Country:US
Practice Address - Phone:360-748-2274
Practice Address - Fax:360-748-2276
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60921223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)