Individual
MR. GARY J FREDERICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
4422 6TH AVE SE, LACEY, WA 98503-1020
(360) 704-7170
(360) 412-4982
Mailing address
4422 6TH AVE SE, LACEY, WA 98503-1020
(360) 704-7170
(360) 412-4982
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LW00004165
WA
1041C0700X
Clinical Social Worker
Primary
LW00004165
WA
Other
Enumeration date
11/20/2006
Last updated
07/20/2007
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