Provider Demographics
NPI:1457426330
Name:CARRAWAY, VIVIAN L (VIVIAN CARRAWAY)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:L
Last Name:CARRAWAY
Suffix:
Gender:F
Credentials:VIVIAN CARRAWAY
Other - Prefix:DR
Other - First Name:V.
Other - Middle Name:LORI
Other - Last Name:CARRAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8411 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-5337
Mailing Address - Country:US
Mailing Address - Phone:425-454-2250
Mailing Address - Fax:
Practice Address - Street 1:1902 120TH PL SE STE 104
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6292
Practice Address - Country:US
Practice Address - Phone:206-890-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5302CAOtherRIDER NUMBER, REGENCE