Healthcare Provider Details

I. General information

NPI: 1093810715
Provider Name (Legal Business Name): WENDY LEE DEL MAR MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. WENDY LEE SMITH

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 SE MILL PLAIN BLVD
VANCOUVER WA
98684-6055
US

IV. Provider business mailing address

12607 SE MILL PLAIN BLVD
VANCOUVER WA
98684-6055
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-4460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1856
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00004726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: