Provider Demographics
NPI:1790969962
Name:MAYES, CAROL LEE (MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:MAYES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:KLEIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4649 SUNNYSIDE AVE N STE 344
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6955
Mailing Address - Country:US
Mailing Address - Phone:206-817-3036
Mailing Address - Fax:
Practice Address - Street 1:4649 SUNNYSIDE AVE N STE 344
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6955
Practice Address - Country:US
Practice Address - Phone:206-817-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000060911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8879944OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)