Provider Demographics
NPI:1528346947
Name:OKOLOKO, LARA (LICSW)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:OKOLOKO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9483
Mailing Address - Country:US
Mailing Address - Phone:206-588-5202
Mailing Address - Fax:
Practice Address - Street 1:10303 MERIDIAN AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9483
Practice Address - Country:US
Practice Address - Phone:206-588-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC601081191041C0700X
WALW603130681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical