Provider Demographics
NPI:1639786262
Name:CAROTHERS, CHARINA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CHARINA
Middle Name:
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 S RICHARD ALLEN CT STE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2345
Mailing Address - Country:US
Mailing Address - Phone:509-496-0320
Mailing Address - Fax:
Practice Address - Street 1:631 S RICHARD ALLEN CT STE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2345
Practice Address - Country:US
Practice Address - Phone:509-795-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610334291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical