Provider Demographics
NPI:1962719948
Name:HERNANDEZ, ROCHELLE TRACIE (CA)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:TRACIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:LACKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WA
Mailing Address - Street 1:1520 NE RIDDELL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3005
Mailing Address - Country:US
Mailing Address - Phone:360-228-2959
Mailing Address - Fax:916-473-5766
Practice Address - Street 1:1520 NE RIDDELL RD STE 110
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3005
Practice Address - Country:US
Practice Address - Phone:360-228-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-11
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61644865101YA0400X
CAB001910425101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)