Healthcare Provider Details

I. General information

NPI: 1003183328
Provider Name (Legal Business Name): FLETCHER COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NE PARK PLAZA DR SUITE 292
VANCOUVER WA
98684-5808
US

IV. Provider business mailing address

201 NE PARK PLAZA DR SUITE 292
VANCOUVER WA
98684-5808
US

V. Phone/Fax

Practice location:
  • Phone: 360-524-5879
  • Fax: 360-326-1834
Mailing address:
  • Phone: 360-524-5879
  • Fax: 360-326-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 00004167
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 00004883
License Number StateWA

VIII. Authorized Official

Name: MRS. ANITA LOUISE FLETCHER
Title or Position: THERAPIST
Credential: LMHC
Phone: 360-524-5879