Provider Demographics
NPI:1942849054
Name:ROETCISOENDER, CARMA J (LMHCA)
Entity Type:Individual
Prefix:
First Name:CARMA
Middle Name:J
Last Name:ROETCISOENDER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-5117
Mailing Address - Country:US
Mailing Address - Phone:360-303-4966
Mailing Address - Fax:
Practice Address - Street 1:1316 KING ST STE 4
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6263
Practice Address - Country:US
Practice Address - Phone:360-389-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60920289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health