Active NPI
Beratta J Gomillion
- Addiction (Substance Use Disorder) Counselor
- Shoreline, WA
National Provider Identifier
1972942787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CP00000674
- Practice address
- 17018 15TH Ave NE
Shoreline, WA 98155-5126 - Phone
- (206) 362-7282
- Fax
- (206) 362-7152
- NPI assigned
- Jun 14, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CP00000674 | WA | Primary |
Addresses
Primary practice location
17018 15TH Ave NE
Shoreline, WA 98155-5126
Mailing address
17018 15TH Ave NE
Shoreline, WA 98155-5126
Phone (206) 362-7282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP00000674 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371168000000",
"number": "1972942787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17018 15TH AVE NE",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981555126",
"telephone_number": "206-362-7282",
"fax_number": "206-362-7152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17018 15TH AVE NE",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981555126",
"telephone_number": "206-362-7282",
"fax_number": "206-362-7152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMILLION",
"first_name": "BERATTA",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-14",
"last_updated": "2013-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CP00000674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreline, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.