Provider Demographics
NPI:1659138691
Name:COLE, VALKYRIE (LSWAIC)
Entity Type:Individual
Prefix:
First Name:VALKYRIE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22708 38TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4504
Mailing Address - Country:US
Mailing Address - Phone:425-772-7494
Mailing Address - Fax:
Practice Address - Street 1:8120 HARDESON RD UNIT 4376
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-0118
Practice Address - Country:US
Practice Address - Phone:062-450-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC614673241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical