Provider Demographics
NPI:1528317310
Name:CAVANAUGH, ANNA WESCOTT (BA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:WESCOTT
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:9330 59TH AVENUE SOUTHWEST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-620-5015
Mailing Address - Fax:253-620-5831
Practice Address - Street 1:9330 59TH AVENUE SOUTHWEST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-620-5015
Practice Address - Fax:253-620-5831
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60262599101YA0400X
WACG60137186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)