Provider Demographics
NPI:1083899652
Name:DRAKE, STEPHANIE ALLISON (MSW, MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 MARKET PL
Mailing Address - Street 2:A-203
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-1552
Mailing Address - Country:US
Mailing Address - Phone:425-478-0368
Mailing Address - Fax:
Practice Address - Street 1:547 DAYTON ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3431
Practice Address - Country:US
Practice Address - Phone:425-771-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00059868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health