Healthcare Provider Details

I. General information

NPI: 1245590942
Provider Name (Legal Business Name): CAROLYN ELIZABETH SKOLNICK M.A. L.M.H.C. C.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8217 20TH AVE NE
SEATTLE WA
98115-4407
US

IV. Provider business mailing address

8217 20TH AVE NE
SEATTLE WA
98115-4407
US

V. Phone/Fax

Practice location:
  • Phone: 206-915-8685
  • Fax:
Mailing address:
  • Phone: 206-915-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60043925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: