Provider Demographics
NPI:1336118280
Name:ARRIAGA-THORNE, VICKIE LAURETTA (MSW)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LAURETTA
Last Name:ARRIAGA-THORNE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:LAURETTA
Other - Last Name:ARRIAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1103 W IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2604
Mailing Address - Country:US
Mailing Address - Phone:208-818-3581
Mailing Address - Fax:208-667-9756
Practice Address - Street 1:1103 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2604
Practice Address - Country:US
Practice Address - Phone:208-818-3581
Practice Address - Fax:208-667-9756
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT2973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806474100Medicaid
ID000010154671OtherREGENCE BLUE SHIELD