Provider Demographics
NPI:1962265520
Name:LAFAELE, VIRGINIA LEE (CO61226413)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:LAFAELE
Suffix:
Gender:F
Credentials:CO61226413
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5126
Mailing Address - Country:US
Mailing Address - Phone:253-536-6425
Mailing Address - Fax:253-536-6637
Practice Address - Street 1:12201 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5126
Practice Address - Country:US
Practice Address - Phone:253-536-6425
Practice Address - Fax:253-536-6637
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61226413101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)