=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003262957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEVERLY J CARMAN SUDP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2016
-----------------------------------------------------
Last Update Date | 01/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8212 S MARCH POINT RD
-----------------------------------------------------
City | ANACORTES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98221-8684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-588-2800
-----------------------------------------------------
Fax | 360-588-2808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 W TROXELL RD
-----------------------------------------------------
City | OAK HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98277-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-848-8437
-----------------------------------------------------
Fax | 360-848-5250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP60235502
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------