Provider Demographics
NPI:1538332721
Name:LEWIS, LAURA M (CDP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12503 SE MILL PLAIN BLVD STE 119A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4007
Mailing Address - Country:US
Mailing Address - Phone:360-314-6507
Mailing Address - Fax:360-852-8041
Practice Address - Street 1:12503 SE MILL PLAIN BLVD
Practice Address - Street 2:119A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4009
Practice Address - Country:US
Practice Address - Phone:360-314-6507
Practice Address - Fax:360-852-8041
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP0002893101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)