Healthcare Provider Details

I. General information

NPI: 1134972672
Provider Name (Legal Business Name): ELISACAROLS ENCARNACION
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: LI ENCARNACION

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

IV. Provider business mailing address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-6200
  • Fax:
Mailing address:
  • Phone: 425-349-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG61552170
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: