Provider Demographics
NPI:1982182846
Name:LIGHTFOOT, VANESSA BROOKE (BASW AARC CDP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:BROOKE
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:BASW AARC CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3532
Mailing Address - Country:US
Mailing Address - Phone:509-529-6036
Mailing Address - Fax:855-927-0099
Practice Address - Street 1:2802 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3642
Practice Address - Country:US
Practice Address - Phone:425-259-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6082656101YA0400X
WACG6083778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)