Individual
MS. LYNETTE EFFIE TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP, LICSW
Contact information
Practice address
1601 E FOURTH PLAIN BLVD, BLDG 17, VANCOUVER, WA 98661-3753
(360) 397-8246
(360) 397-8450
Mailing address
1601 E 4TH PLAIN BLVD, VANCOUVER, WA 98661-3753
(360) 397-8246
(360) 397-8450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00005446
WA
1041C0700X
Clinical Social Worker
LW 60363996
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
10/25/2006
Last updated
06/10/2013
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