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General NPI Number Information
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NPI Number | 1629518394
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Entity Type | Organization
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Legal Business Name | COUNSELING SERVICES OF OLYMPIA, LLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1015 4TH AVE W STE H
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City | OLYMPIA
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State | WA
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Zip | 98502-5492
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Country | US
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Telephone | 360-349-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 4TH AVE W STE H
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City | OLYMPIA
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State | WA
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Zip | 98502-5492
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Country | US
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Telephone | 360-349-6446
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | LESLIE DEMARCO
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Credential | LMHC
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Telephone | 360-349-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MC60437247
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LH 60604130
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License Number State | WA
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