Healthcare Provider Details

I. General information

NPI: 1134669278
Provider Name (Legal Business Name): CAROLYN M DELEON MA, LMHC LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 NE VANCOUVER MALL DR STE 202
VANCOUVER WA
98662-6191
US

IV. Provider business mailing address

PO BOX 820815
VANCOUVER WA
98682-0018
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-9324
  • Fax:
Mailing address:
  • Phone: 360-487-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61181396
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: