Provider Demographics
NPI:1609301381
Name:PACHEVA, PETYA (MA, LMHC, CDP, MHP)
Entity Type:Individual
Prefix:
First Name:PETYA
Middle Name:
Last Name:PACHEVA
Suffix:
Gender:F
Credentials:MA, LMHC, CDP, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11814
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1814
Mailing Address - Country:US
Mailing Address - Phone:360-763-6426
Mailing Address - Fax:
Practice Address - Street 1:2401 BRISTOL CT SW STE D101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6037
Practice Address - Country:US
Practice Address - Phone:360-763-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60296151101YA0400X
WALH60640104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)