Provider Demographics
NPI:1770769648
Name:MEJORADO, ANTONIA ROSZITA (LMHC, SUDP)
Entity type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:ROSZITA
Last Name:MEJORADO
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-1470
Mailing Address - Country:US
Mailing Address - Phone:206-227-0261
Mailing Address - Fax:
Practice Address - Street 1:9575 ETHAN WADE WAY SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9577
Practice Address - Country:US
Practice Address - Phone:425-831-5425
Practice Address - Fax:425-831-5428
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005924101YA0400X
WALH60647519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)