Provider Demographics
NPI:1730495730
Name:WINGE, KARRE ROSE (LMFT, CADCII)
Entity Type:Individual
Prefix:MS
First Name:KARRE
Middle Name:ROSE
Last Name:WINGE
Suffix:
Gender:F
Credentials:LMFT, CADCII
Other - Prefix:MISS
Other - First Name:KARRE
Other - Middle Name:ROSE
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC II
Mailing Address - Street 1:11980 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5172
Mailing Address - Country:US
Mailing Address - Phone:909-864-1097
Mailing Address - Fax:
Practice Address - Street 1:607 DONNA WAY
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5517
Practice Address - Country:US
Practice Address - Phone:951-654-0803
Practice Address - Fax:951-487-2448
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208101YA0400X
CAPCCI3905101YP2500X
CAIMF99922106H00000X
CALMFT120153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTHERMedicaid