Healthcare Provider Details

I. General information

NPI: 1770642290
Provider Name (Legal Business Name): CAROLYN GAY RODENBERG MA, LMFT, CCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N 115TH ST SUITE 207
SEATTLE WA
98133
US

IV. Provider business mailing address

PO BOX 11009
OLYMPIA WA
98508-1009
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-3058
  • Fax: 206-523-1252
Mailing address:
  • Phone: 360-352-2037
  • Fax: 360-352-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF0000863
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: