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Organization

NICOLE T SHIRAEV, LICSW, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. NICOLE T SHIRAEV LICSW (PSYCHOTHERAPIST/SOLE PROPRIETOR)
(540) 808-5343
Entity
Organization

Contact information

Practice address
150 NICKERSON ST, SUITE #105, SEATTLE, WA 98109-1634
(540) 808-5343
Mailing address
150 NICKERSON ST, SUITE #105, SEATTLE, WA 98109-1634
(540) 808-5343

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60091324
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1619164407
INDIVIDUAL NPI
Enumeration date
10/25/2014
Last updated
10/25/2014
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