Healthcare Provider Details

I. General information

NPI: 1083135131
Provider Name (Legal Business Name): BEAKIE JORELISSE COLON RIVERA LCSWA, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

4510 FAWCETT AVE
TACOMA WA
98418-6635
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61092498
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP.61044605
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: