Provider Demographics
NPI:1073944559
Name:GRACE, CARLA (LMCH, LPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:LMCH, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3324
Mailing Address - Country:US
Mailing Address - Phone:206-552-1543
Mailing Address - Fax:
Practice Address - Street 1:9055 11TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3324
Practice Address - Country:US
Practice Address - Phone:206-552-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5424101YP2500X
WALH60829337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional