Provider Demographics
NPI:1053821769
Name:RICHARDSON, LAURIE ANN (COUNSELOR)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 COMMERCE ST. MDS-101
Mailing Address - Street 2:PO BOX 358455
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3100
Mailing Address - Country:US
Mailing Address - Phone:253-692-4711
Mailing Address - Fax:
Practice Address - Street 1:1900 COMMERCE ST # ST-101
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3112
Practice Address - Country:US
Practice Address - Phone:253-692-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician