Provider Demographics
NPI:1366777849
Name:DEVINE, LUCRETIA M (LMHC)
Entity type:Individual
Prefix:MS
First Name:LUCRETIA
Middle Name:M
Last Name:DEVINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:LUCRETIA
Other - Middle Name:M
Other - Last Name:DEBENEDETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5816 REID DR NW
Mailing Address - Street 2:P.O. BOX 534
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1342
Mailing Address - Country:US
Mailing Address - Phone:253-851-5023
Mailing Address - Fax:253-851-5023
Practice Address - Street 1:5816 REID DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1342
Practice Address - Country:US
Practice Address - Phone:253-851-5023
Practice Address - Fax:253-851-5023
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health