Healthcare Provider Details

I. General information

NPI: 1447505615
Provider Name (Legal Business Name): ANA MARIA MEJIA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 04/29/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 UNION AVE SE
OLYMPIA WA
98501-1429
US

IV. Provider business mailing address

5122 E BROCKDALE RD
SHELTON WA
98584-7488
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-0839
  • Fax: 360-925-3244
Mailing address:
  • Phone: 305-562-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: