Provider Demographics
NPI:1427660778
Name:DUPONT-ERICKSON, VERONICA MELISSA (CG61025887)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:MELISSA
Last Name:DUPONT-ERICKSON
Suffix:
Gender:F
Credentials:CG61025887
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:M
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2733 S 125TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2487
Mailing Address - Country:US
Mailing Address - Phone:360-589-0903
Mailing Address - Fax:
Practice Address - Street 1:3436 MARY ELDER RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5050
Practice Address - Country:US
Practice Address - Phone:360-528-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61025887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health