Provider Demographics
NPI:1770959348
Name:HASTY-VANNOY, ADAIR LOUISE (LMHC CMHS MHP)
Entity type:Individual
Prefix:
First Name:ADAIR
Middle Name:LOUISE
Last Name:HASTY-VANNOY
Suffix:
Gender:F
Credentials:LMHC CMHS MHP
Other - Prefix:
Other - First Name:ADAIR
Other - Middle Name:LOUISE
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LMHC MHP CS
Mailing Address - Street 1:PO BOX 59284
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2284
Mailing Address - Country:US
Mailing Address - Phone:206-816-2706
Mailing Address - Fax:253-236-4107
Practice Address - Street 1:24437 RUSSELL RD STE 230
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4950
Practice Address - Country:US
Practice Address - Phone:206-816-2706
Practice Address - Fax:253-852-0720
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60245673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health