Provider Demographics
NPI:1942712823
Name:LAINES, LETICIA NICKOLE (MSW, LSWAIC, MHP)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:NICKOLE
Last Name:LAINES
Suffix:
Gender:F
Credentials:MSW, LSWAIC, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2339
Mailing Address - Country:US
Mailing Address - Phone:206-322-2387
Mailing Address - Fax:
Practice Address - Street 1:2212 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2339
Practice Address - Country:US
Practice Address - Phone:206-322-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607835221041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical