Provider Demographics
NPI:1417787185
Name:DUDLEY, MANISHA (LMHCA)
Entity type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2835
Mailing Address - Country:US
Mailing Address - Phone:206-883-3904
Mailing Address - Fax:
Practice Address - Street 1:200 1ST AVE W STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4219
Practice Address - Country:US
Practice Address - Phone:425-361-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61577239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health