Provider Demographics
NPI:1093059479
Name:CAROL PENDLETON, LLC
Entity Type:Organization
Organization Name:CAROL PENDLETON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFTA, CMHS,
Authorized Official - Phone:206-355-8532
Mailing Address - Street 1:11718 ARROW POINT DR NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1425
Mailing Address - Country:US
Mailing Address - Phone:206-355-8532
Mailing Address - Fax:
Practice Address - Street 1:11718 ARROW POINT DR NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1425
Practice Address - Country:US
Practice Address - Phone:206-355-8532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60307219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty