Provider Demographics
NPI:1609994607
Name:KROLL, BERNIECE LILLIAN (CDP, LMHP)
Entity Type:Individual
Prefix:MS
First Name:BERNIECE
Middle Name:LILLIAN
Last Name:KROLL
Suffix:
Gender:F
Credentials:CDP, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N ROAD 32
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3869
Mailing Address - Country:US
Mailing Address - Phone:509-546-2375
Mailing Address - Fax:509-546-2360
Practice Address - Street 1:520 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5257
Practice Address - Country:US
Practice Address - Phone:509-546-2375
Practice Address - Fax:509-546-2360
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000464101YA0400X
WALH00008959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health