Provider Demographics
NPI:1699132316
Name:VANTRIES, DONNETTE K
Entity type:Individual
Prefix:MS
First Name:DONNETTE
Middle Name:K
Last Name:VANTRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DONNETTE
Other - Middle Name:K
Other - Last Name:VANTRIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDP
Mailing Address - Street 1:7507 NE 51ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6007
Mailing Address - Country:US
Mailing Address - Phone:360-906-1190
Mailing Address - Fax:
Practice Address - Street 1:7507 NE 51ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6007
Practice Address - Country:US
Practice Address - Phone:360-906-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000769101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)