Provider Demographics
NPI:1649791336
Name:DELONG, LARRI SHARON (BA, CAAR)
Entity type:Individual
Prefix:
First Name:LARRI SHARON
Middle Name:
Last Name:DELONG
Suffix:
Gender:F
Credentials:BA, CAAR
Other - Prefix:
Other - First Name:LARRI SHARON
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA , CAAR
Mailing Address - Street 1:205 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-2507
Mailing Address - Country:US
Mailing Address - Phone:360-532-8629
Mailing Address - Fax:360-532-8789
Practice Address - Street 1:205 8TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2507
Practice Address - Country:US
Practice Address - Phone:360-532-8629
Practice Address - Fax:360-532-8789
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60151314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA100274Medicaid
WACG60151314Medicaid