Healthcare Provider Details

I. General information

NPI: 1730774456
Provider Name (Legal Business Name): LORRAINE PHILLIPS POOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-5868
US

IV. Provider business mailing address

1000 JEFFERSON ST STE 2C
LYNCHBURG VA
24504-1724
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number81566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: