Provider Demographics
NPI:1629229075
Name:ERICKSON, CARRIE S (LMFT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:S
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 114TH AVE SE STE 224
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6905
Mailing Address - Country:US
Mailing Address - Phone:206-240-0212
Mailing Address - Fax:
Practice Address - Street 1:1621 114TH AVE SE
Practice Address - Street 2:STE 224
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1111
Practice Address - Country:US
Practice Address - Phone:206-240-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist