Provider Demographics
NPI:1033169032
Name:WALSH, CAROLYN HUNTER (MSW, LCMHC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:HUNTER
Last Name:WALSH
Suffix:
Gender:F
Credentials:MSW, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 CREEKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2469
Mailing Address - Country:US
Mailing Address - Phone:802-223-4536
Mailing Address - Fax:866-233-1953
Practice Address - Street 1:619 COMMERCIAL AVE STE 31
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1730
Practice Address - Country:US
Practice Address - Phone:802-223-4536
Practice Address - Fax:866-233-1953
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60409168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
18806OtherBC/BS PREFERRED PROVIDER
VT347479OtherMVP PROVIDER NUMBER
VT1007182Medicaid