Provider Demographics
NPI:1558879023
Name:CARRIE POPE, MSW, LICSW, PLLC
Entity Type:Organization
Organization Name:CARRIE POPE, MSW, LICSW, PLLC
Other - Org Name:CARRIE POPE, MSW, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:425-345-0758
Mailing Address - Street 1:131 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6201
Mailing Address - Country:US
Mailing Address - Phone:425-345-0758
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 415
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8969
Practice Address - Country:US
Practice Address - Phone:425-345-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60640903251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health