Provider Demographics
NPI:1992331367
Name:CREDGINGTON, ERNEST A
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:A
Last Name:CREDGINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 25TH AVE NE # 120
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4183
Mailing Address - Country:US
Mailing Address - Phone:206-617-3373
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 304
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8967
Practice Address - Country:US
Practice Address - Phone:206-617-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMG61171792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor