Provider Demographics
NPI:1710034442
Name:FAULKNER, ELAINE MARGARET (CDP-T)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARGARET
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:CDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6068 MEADOW CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8722
Mailing Address - Country:US
Mailing Address - Phone:360-380-6219
Mailing Address - Fax:
Practice Address - Street 1:2806 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6930
Practice Address - Country:US
Practice Address - Phone:360-676-2187
Practice Address - Fax:360-676-2162
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053509101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor