Provider Demographics
NPI:1548676547
Name:CORREA, LUCILLE C (LICSW)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:C
Last Name:CORREA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7762 CASCADES DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98266-7713
Mailing Address - Country:US
Mailing Address - Phone:360-224-2631
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST STE 608
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5024
Practice Address - Country:US
Practice Address - Phone:360-224-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60594466101YM0800X
WALW 607063631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038669Medicaid