Provider Demographics
NPI:1003018839
Name:FREDERICKSON, CINDY MARIE (MA, LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MARIE
Last Name:FREDERICKSON
Suffix:
Gender:F
Credentials:MA, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-8721
Mailing Address - Country:US
Mailing Address - Phone:425-308-4011
Mailing Address - Fax:425-258-9320
Practice Address - Street 1:1106 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4335
Practice Address - Country:US
Practice Address - Phone:360-653-0374
Practice Address - Fax:360-658-0219
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00051356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health