Provider Demographics
NPI:1346958741
Name:DEAN, CAROLINE ROSEMARY ALICE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ROSEMARY ALICE
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18401 BRITCHEN ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8965
Mailing Address - Country:US
Mailing Address - Phone:336-912-0991
Mailing Address - Fax:
Practice Address - Street 1:18401 BRITCHEN ST SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8965
Practice Address - Country:US
Practice Address - Phone:360-960-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WASC614939441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health