Provider Demographics
NPI:1609325737
Name:BLAIR, ROSA CARMEN (LMHCA)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:CARMEN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 PROHASKA RD
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-6094
Mailing Address - Country:US
Mailing Address - Phone:360-298-0811
Mailing Address - Fax:
Practice Address - Street 1:1012 TERRA BELLA LN
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8091
Practice Address - Country:US
Practice Address - Phone:360-298-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60629212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health