Provider Demographics
NPI:1164889705
Name:ROADS, CARLINE K (CDP)
Entity Type:Individual
Prefix:MS
First Name:CARLINE
Middle Name:K
Last Name:ROADS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-8020
Mailing Address - Country:US
Mailing Address - Phone:253-680-2672
Mailing Address - Fax:253-779-0801
Practice Address - Street 1:1016 S 28TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-8020
Practice Address - Country:US
Practice Address - Phone:253-680-2672
Practice Address - Fax:253-779-0801
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00002434101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)