Individual
MARY ANN LACOURSIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP
Contact information
Practice address
1412 SW 43RD ST STE 140, RENTON, WA 98057-4803
(425) 264-0750
(425) 264-0799
Mailing address
1700 AIRPORT WAY S, SEATTLE, WA 98134-1618
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60793298
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043713332
—
WA
Enumeration date
03/13/2018
Last updated
07/09/2024
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