Provider Demographics
NPI:1902620743
Name:SURFACE, SHAWNA M (MHCA SUDPT)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:SURFACE
Suffix:
Gender:F
Credentials:MHCA SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 151ST ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-1650
Mailing Address - Country:US
Mailing Address - Phone:253-495-0004
Mailing Address - Fax:
Practice Address - Street 1:4021 151ST ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-1650
Practice Address - Country:US
Practice Address - Phone:253-495-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC061489646101YA0400X
WAMC61583699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)