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General NPI Number Information
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NPI Number | 1114400595
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Entity Type | Individual
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Provider Name | DAVID CARLILE
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Gender | Male
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 6505 216TH ST SW STE 100
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2089
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Country | US
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Telephone | 503-580-7207
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Fax |
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Provider Business Mailing Address
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Address Line | 12901 NE 28TH ST APT 62
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City | VANCOUVER
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State | WA
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Zip | 98682-1224
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Country | US
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Telephone | 503-580-7207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC61321595
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License Number State | WA
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