Healthcare Provider Details

I. General information

NPI: 1841108115
Provider Name (Legal Business Name): ANDREA MAY COOK SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12850 LALA COVE LN SE
OLALLA WA
98359-9664
US

IV. Provider business mailing address

12850 LALA COVE LN SE
OLALLA WA
98359-9664
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-6201
  • Fax: 253-857-3993
Mailing address:
  • Phone: 253-857-6201
  • Fax: 253-857-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: