Provider Demographics
NPI:1447403597
Name:WAY, CAROL ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNE
Last Name:WAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 GRAVENSTEIN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4555
Mailing Address - Country:US
Mailing Address - Phone:707-321-0803
Mailing Address - Fax:
Practice Address - Street 1:874 GRAVENSTEIN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4555
Practice Address - Country:US
Practice Address - Phone:707-321-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13828103TB0200X, 103TC0700X, 103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy