Provider Demographics
NPI:1386439321
Name:SHEA, DANIEL JAMES (SUDPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:SHEA
Suffix:
Gender:
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 MANSFIELD ST STE 6
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3588
Mailing Address - Country:US
Mailing Address - Phone:509-942-1624
Mailing Address - Fax:
Practice Address - Street 1:1305 MANSFIELD ST STE 6
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3588
Practice Address - Country:US
Practice Address - Phone:509-942-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61602722101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)