Provider Demographics
NPI:1013205020
Name:POKRIFCHAK, ROSE AMARA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:AMARA
Last Name:POKRIFCHAK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:AMARA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 E BIRCH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3205
Mailing Address - Country:US
Mailing Address - Phone:541-621-1271
Mailing Address - Fax:
Practice Address - Street 1:19 E BIRCH ST
Practice Address - Street 2:STE 101
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3205
Practice Address - Country:US
Practice Address - Phone:541-621-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60424383101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health