Provider Demographics
NPI:1912394404
Name:CHING, JERRICA KWAI FAH (LMHC, LMFT, CMHS)
Entity Type:Individual
Prefix:MISS
First Name:JERRICA
Middle Name:KWAI FAH
Last Name:CHING
Suffix:
Gender:F
Credentials:LMHC, LMFT, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 NE 51ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6007
Mailing Address - Country:US
Mailing Address - Phone:360-906-1190
Mailing Address - Fax:
Practice Address - Street 1:7507 NE 51ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6007
Practice Address - Country:US
Practice Address - Phone:360-906-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60857196101YM0800X
HIMHC-837101YM0800X
ORC5880101YP2500X
WALF61023668106H00000X
WA60857196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2097595Medicaid
WACG60486635OtherCAAR