Healthcare Provider Details

I. General information

NPI: 1124515267
Provider Name (Legal Business Name): SUSAN LAUGHLIN CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN REID

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 04/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 14TH AVE
LONGVIEW WA
98632-2316
US

IV. Provider business mailing address

921 14TH AVE
LONGVIEW WA
98632-2316
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0203
  • Fax: 360-423-2311
Mailing address:
  • Phone: 360-423-0203
  • Fax: 360-577-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60776697
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60844092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: