Healthcare Provider Details

I. General information

NPI: 1093059479
Provider Name (Legal Business Name): CAROL PENDLETON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11718 ARROW POINT DR NE
BAINBRIDGE ISLAND WA
98110-1425
US

IV. Provider business mailing address

11718 ARROW POINT DR NE
BAINBRIDGE ISLAND WA
98110-1425
US

V. Phone/Fax

Practice location:
  • Phone: 206-355-8532
  • Fax:
Mailing address:
  • Phone: 206-355-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60307219
License Number StateWA

VIII. Authorized Official

Name: CAROL PENDLETON
Title or Position: THERAPIST
Credential: MA, LMFTA, CMHS,
Phone: 206-355-8532