Provider Demographics
NPI:1003007444
Name:LAURSEN, BLANCA V (SUDP)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:V
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 E COLLEGE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5612
Mailing Address - Country:US
Mailing Address - Phone:360-763-5595
Mailing Address - Fax:360-399-7639
Practice Address - Street 1:1601 E COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5612
Practice Address - Country:US
Practice Address - Phone:360-763-5595
Practice Address - Fax:360-399-7639
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00039617101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)