Provider Demographics
NPI:1447505615
Name:MEJIA, ANA MARIA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARIA
Last Name:MEJIA
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 1:5122 E BROCKDALE RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7488
Mailing Address - Country:US
Mailing Address - Phone:305-562-0839
Mailing Address - Fax:
Practice Address - Street 1:508 UNION AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1429
Practice Address - Country:US
Practice Address - Phone:305-562-0839
Practice Address - Fax:360-925-3244
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WALW603782561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083001135OtherORGANIZATION NPI