Provider Demographics
NPI:1265589675
Name:ARVIN, CAROL BREEDING (MA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:BREEDING
Last Name:ARVIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W HOLLY ST
Mailing Address - Street 2:SUITE 324
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4364
Mailing Address - Country:US
Mailing Address - Phone:360-650-1591
Mailing Address - Fax:360-647-8826
Practice Address - Street 1:203 W HOLLY ST
Practice Address - Street 2:SUITE 324
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4364
Practice Address - Country:US
Practice Address - Phone:360-650-1591
Practice Address - Fax:360-647-8826
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00009294OtherLICENSE