Provider Demographics
NPI:1659119873
Name:HADDIX, VIVIANDRIA
Entity type:Individual
Prefix:
First Name:VIVIANDRIA
Middle Name:
Last Name:HADDIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10344 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1689
Mailing Address - Country:US
Mailing Address - Phone:206-767-0244
Mailing Address - Fax:
Practice Address - Street 1:10344 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1689
Practice Address - Country:US
Practice Address - Phone:206-767-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102X00000X, 101YM0800X, 103TA0400X, 225XM0800X, 246RP1900X, 261QR0800X, 101YA0400X
WVT-22-1923101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care