Provider Demographics
NPI:1497219844
Name:GRACEY, CINDY M (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:M
Last Name:GRACEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11232 SE 267TH PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7179
Mailing Address - Country:US
Mailing Address - Phone:206-931-4945
Mailing Address - Fax:
Practice Address - Street 1:11232 SE 267TH PL
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7179
Practice Address - Country:US
Practice Address - Phone:206-931-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2024-04-02
Deactivation Date:2023-06-07
Deactivation Code:
Reactivation Date:2023-06-26
Provider Licenses
StateLicense IDTaxonomies
WASC610788611041C0700X
106S00000X
WALW615314761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician