Provider Demographics
NPI:1033657309
Name:TOTTEN, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TOTTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-5007
Mailing Address - Country:US
Mailing Address - Phone:360-391-9729
Mailing Address - Fax:360-757-7749
Practice Address - Street 1:1960 THOMPSON DR.
Practice Address - Street 2:
Practice Address - City:SEDRO-WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-391-9729
Practice Address - Fax:360-757-7749
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC603412431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical