Provider Demographics
NPI:1083964670
Name:WILLEMAIN, JOAN PATRICE (LICSW,CMHS)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:PATRICE
Last Name:WILLEMAIN
Suffix:
Gender:F
Credentials:LICSW,CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 12TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2908
Mailing Address - Country:US
Mailing Address - Phone:206-466-8225
Mailing Address - Fax:
Practice Address - Street 1:9226 12TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2908
Practice Address - Country:US
Practice Address - Phone:206-466-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000061821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical