Healthcare Provider Details

I. General information

NPI: 1396138426
Provider Name (Legal Business Name): AQUILINE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27010 190TH AVE SE
COVINGTON WA
98042-8486
US

IV. Provider business mailing address

304 MAIN AVE S STE 301
RENTON WA
98057-2758
US

V. Phone/Fax

Practice location:
  • Phone: 206-914-0426
  • Fax:
Mailing address:
  • Phone: 206-914-0426
  • Fax: 888-972-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60450981
License Number StateWA

VIII. Authorized Official

Name: SANDRA TUDOR
Title or Position: OWNER/COUNSELOR
Credential: LMHC
Phone: 206-914-0426