Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003179862 |
---|---|
Provider Name | Lisa Sigrid Coley |
First Address | Seattle, WA 98144-4801 |
Second Address | Vashon, WA 98070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 18/06/2012 |