Provider Demographics
NPI:1558702936
Name:EDELSTEIN, LAURA NICOLE (MA, CDP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NICOLE
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:MA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19435 68TH AVE S STE S109
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2114
Mailing Address - Country:US
Mailing Address - Phone:425-251-1933
Mailing Address - Fax:425-251-4996
Practice Address - Street 1:19435 68TH AVE S STE S109
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2114
Practice Address - Country:US
Practice Address - Phone:425-251-1933
Practice Address - Fax:425-251-4996
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60080404101YA0400X
WALH60537126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)