Provider Demographics
NPI:1841461571
Name:DEVINE, ELIZABETH RALEIGH (MSW, LICSW, CDP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RALEIGH
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MSW, LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S 2ND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2017
Mailing Address - Country:US
Mailing Address - Phone:425-203-7201
Mailing Address - Fax:
Practice Address - Street 1:419 S 2ND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2017
Practice Address - Country:US
Practice Address - Phone:425-203-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006247101YA0400X
WALW000095481041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)