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Individual
SEMI GREY
Active
Individual
SEMI GREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, SUDP, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP61381857
WA
101YM0800X
Mental Health Counselor
Primary
LH61583980
WA
101YM0800X
Mental Health Counselor
R8879
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669411377
NPN
—
01
—
C9921
LICENSED PROFESSIONAL COUNSELOR
OR
01
—
CP61381857
SUDP
WA
01
—
LH61583980
WASHINGTON STATE DOH
WA
Enumeration date
11/28/2018
Last updated
07/01/2025
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