Provider Demographics
NPI:1558320416
Name:SARGENT, CAROLYN
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:SARGENT
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 1:8382 W GAGE BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8382 W GAGE BLVD
Practice Address - Street 2:STE. B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8104
Practice Address - Country:US
Practice Address - Phone:509-528-1300
Practice Address - Fax:509-627-5307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health