Provider Demographics
NPI:1528884707
Name:SPRAYBERRY, MARY A (CO61603715)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:A
Last Name:SPRAYBERRY
Suffix:
Gender:F
Credentials:CO61603715
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4632
Mailing Address - Country:US
Mailing Address - Phone:360-338-0600
Mailing Address - Fax:360-338-0601
Practice Address - Street 1:1905 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4631
Practice Address - Country:US
Practice Address - Phone:360-338-0600
Practice Address - Fax:360-338-0601
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61603715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)