Provider Demographics
NPI:1275304651
Name:PROVIDENTIAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:PROVIDENTIAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-795-0150
Mailing Address - Street 1:631 S RICHARD ALLEN CT # 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2345
Mailing Address - Country:US
Mailing Address - Phone:509-795-0150
Mailing Address - Fax:866-635-0840
Practice Address - Street 1:631 S RICHARD ALLEN CT # 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2345
Practice Address - Country:US
Practice Address - Phone:509-795-0150
Practice Address - Fax:866-635-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty