Provider Demographics
NPI:1942770896
Name:GREATHOUSE, DORET MONICA (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:DORET
Middle Name:MONICA
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:DORET
Other - Middle Name:MONICA
Other - Last Name:GREATHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCM
Mailing Address - Street 1:2133 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2385
Mailing Address - Country:US
Mailing Address - Phone:206-432-3574
Mailing Address - Fax:206-432-3575
Practice Address - Street 1:2133 3RD AVE STE 116
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2353
Practice Address - Country:US
Practice Address - Phone:206-432-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1942770896101Y00000X
WACG60835638171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor