Provider Demographics
NPI:1497267181
Name:DOGGRELL-SMITH, LUCY HELEN (MSW)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:HELEN
Last Name:DOGGRELL-SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:8512 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8222
Mailing Address - Country:US
Mailing Address - Phone:206-972-4276
Mailing Address - Fax:
Practice Address - Street 1:1 LAKE BELLEVUE DR STE 204B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:425-462-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WASC61027818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker