Healthcare Provider Details

I. General information

NPI: 1679018113
Provider Name (Legal Business Name): ANGELA LYNN PEARSON LSWAIC, LAAC, SUDP,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA L. PEARSON MSW, LSWAIC, SUDP

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21107 ELBERTA RD # 2
LYNNWOOD WA
98036-8658
US

IV. Provider business mailing address

21107 ELBERTA RD # 2
LYNNWOOD WA
98036-8658
US

V. Phone/Fax

Practice location:
  • Phone: 206-678-6434
  • Fax:
Mailing address:
  • Phone: 206-678-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60344301
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCAAL.CU.70011565
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC61681558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: