Healthcare Provider Details

I. General information

NPI: 1730495730
Provider Name (Legal Business Name): KARRE ROSE WINGE LMFT, CADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARRE ROSE PALACIOS CADC II

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 01/26/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 DONNA WAY
SAN JACINTO CA
92583-5517
US

IV. Provider business mailing address

11980 MOUNT VERNON AVE
GRAND TERRACE CA
92313-5172
US

V. Phone/Fax

Practice location:
  • Phone: 951-654-0803
  • Fax: 951-487-2448
Mailing address:
  • Phone: 909-864-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number208
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCCI3905
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF99922
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT120153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: