Provider Demographics
NPI:1639763949
Name:GRESIA COUNSELING & WELLNESS, PLLC
Entity Type:Organization
Organization Name:GRESIA COUNSELING & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PILAR
Authorized Official - Last Name:GRESIA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED SOCIAL WORK
Authorized Official - Phone:360-250-0960
Mailing Address - Street 1:204 CUSTER WAY SW STE B5
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3330
Mailing Address - Country:US
Mailing Address - Phone:360-250-0960
Mailing Address - Fax:
Practice Address - Street 1:204 CUSTER WAY SW STE B5
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3330
Practice Address - Country:US
Practice Address - Phone:360-250-0960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty