Provider Demographics
NPI:1427576347
Name:BANIC, LUCIJA
Entity Type:Individual
Prefix:
First Name:LUCIJA
Middle Name:
Last Name:BANIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34580 HANSVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-8682
Mailing Address - Country:US
Mailing Address - Phone:360-979-6869
Mailing Address - Fax:
Practice Address - Street 1:325 TORMEY LN NE STE 144
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2893
Practice Address - Country:US
Practice Address - Phone:844-701-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61018246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health