Provider Demographics
NPI:1679776686
Name:GUIBERSON, HEATHER CARRIE (LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CARRIE
Last Name:GUIBERSON
Suffix:
Gender:F
Credentials:LMHC, CDP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, CDP
Mailing Address - Street 1:19544 FOREST PARK DR NE
Mailing Address - Street 2:UNIT A
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1218
Mailing Address - Country:US
Mailing Address - Phone:206-851-0272
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N
Practice Address - Street 2:#203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8626
Practice Address - Country:US
Practice Address - Phone:206-851-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00056431101YP2500X
WALH 60104339101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)