Provider Demographics
NPI:1659494839
Name:NOVITSKY, DIONE RABAGO (LCSW)
Entity type:Individual
Prefix:
First Name:DIONE
Middle Name:RABAGO
Last Name:NOVITSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 823405
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 823405
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-0070
Practice Address - Country:US
Practice Address - Phone:408-834-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2024-07-26
Deactivation Date:2009-09-10
Deactivation Code:
Reactivation Date:2012-07-11
Provider Licenses
StateLicense IDTaxonomies
CA720461041C0700X
NY074729-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical