Provider Demographics
NPI:1083853501
Name:TUDOR, DARCIA CARLLETTE (MA, CMHS, WCM, JD)
Entity Type:Individual
Prefix:MS
First Name:DARCIA
Middle Name:CARLLETTE
Last Name:TUDOR
Suffix:
Gender:F
Credentials:MA, CMHS, WCM, JD
Other - Prefix:MS
Other - First Name:DARCIA CARLETTE
Other - Middle Name:CARLLETTE
Other - Last Name:OWINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JD
Mailing Address - Street 1:2018 156TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3825
Mailing Address - Country:US
Mailing Address - Phone:206-547-3166
Mailing Address - Fax:425-883-4751
Practice Address - Street 1:2018 156TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3825
Practice Address - Country:US
Practice Address - Phone:206-547-3166
Practice Address - Fax:425-883-4751
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA12175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist