Basic Information
| Provider Information | |||||||||
| NPI: | 1003007444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAURSEN | ||||||||
| FirstName: | BLANCA | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SUDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 E COLLEGE WAY | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982735612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607635595 | ||||||||
| FaxNumber: | 3603997639 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 E COLLEGE WAY | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982735612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607635595 | ||||||||
| FaxNumber: | 3603997639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RC00039617 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.