Provider Demographics
NPI:1134773062
Name:MARIE, LILLA COLLINGRIDGE (LMHC)
Entity type:Individual
Prefix:
First Name:LILLA
Middle Name:COLLINGRIDGE
Last Name:MARIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22232 17TH AVE SE STE 302
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7425
Mailing Address - Country:US
Mailing Address - Phone:425-487-1005
Mailing Address - Fax:425-487-4884
Practice Address - Street 1:22232 17TH AVE SE STE 302
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7425
Practice Address - Country:US
Practice Address - Phone:425-487-1005
Practice Address - Fax:425-487-4884
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60953543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health