Provider Demographics
NPI:1548886575
Name:GREEN, LAURA E (LSWICA, SUDP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:LSWICA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST STE W
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:501-438-9455
Mailing Address - Fax:
Practice Address - Street 1:41 E EBERHART LN
Practice Address - Street 2:
Practice Address - City:ALLYN
Practice Address - State:WA
Practice Address - Zip Code:98524-8900
Practice Address - Country:US
Practice Address - Phone:501-438-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61064444101YA0400X
WASC615796221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)