Virginia Agustin
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Seattle, WA
NPI 1972087104 · NPPES record last updated Nov 7, 2019
Key facts
- NPI
- 1972087104
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CP60978301 (WA)
- Practice address
- 3639 Martin Luther King Jr Way S
Seattle, WA 98144-6847 - Phone
- (206) 695-7600
- NPI assigned
- Sep 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP60978301 | WA | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CP60978301 | WA | Yes |
Addresses
Primary practice location
3639 Martin Luther King Jr Way S
Seattle, WA 98144-6847
Mailing address
3639 Martin Luther King Jr Way S
Seattle, WA 98144-6847
Phone (206) 695-7600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2113063 | Medicaid | WA |
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- Ainsley Aguspranoto
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- Udas Torty Agwu
- Monika Aha
- Shani Aharon
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All providers in Seattle, WA · Addiction (Substance Use Disorder) Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.