Provider Demographics
NPI:1073862983
Name:RAINE, ROSALIE ELSBETH (MA, LMHCA, CDP, CHT)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:ELSBETH
Last Name:RAINE
Suffix:
Gender:F
Credentials:MA, LMHCA, CDP, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55757
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-0757
Mailing Address - Country:US
Mailing Address - Phone:206-941-7126
Mailing Address - Fax:
Practice Address - Street 1:15879 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6335
Practice Address - Country:US
Practice Address - Phone:206-941-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60214488101YA0400X
WAMC60336435101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor