Provider Demographics
NPI:1750511465
Name:FORD, CAROL LYNN (PHD, CAC I)
Entity Type:Individual
Prefix:
First Name:CAROL LYNN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PHD, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E FIR ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3565
Mailing Address - Country:US
Mailing Address - Phone:970-946-7898
Mailing Address - Fax:
Practice Address - Street 1:912 E FIR ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3565
Practice Address - Country:US
Practice Address - Phone:970-946-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC61040521101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)