Provider Demographics
NPI:1629576905
Name:COCHRAN, CARRIE (MA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 CALIFORNIA TRL
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9790
Mailing Address - Country:US
Mailing Address - Phone:360-223-2442
Mailing Address - Fax:
Practice Address - Street 1:1316 KING ST STE 4
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6263
Practice Address - Country:US
Practice Address - Phone:360-436-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61036497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health