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General NPI Number Information
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NPI Number | 1538332721
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Entity Type | Individual
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Provider Name | LAURA M LEWIS CDP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 12503 SE MILL PLAIN BLVD 119A
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City | VANCOUVER
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State | WA
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Zip | 98684-4009
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Country | US
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Telephone | 360-314-6507
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Fax | 360-852-8041
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Provider Business Mailing Address
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Address Line | 12503 SE MILL PLAIN BLVD STE 119A
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City | VANCOUVER
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State | WA
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Zip | 98684-4007
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Country | US
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Telephone | 360-314-6507
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Fax | 360-852-8041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP0002893
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License Number State | WA
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