Provider Demographics
NPI:1457953192
Name:AKHTAR, CAROLYN CONNERS
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CONNERS
Last Name:AKHTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LUHN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-8655
Mailing Address - Country:US
Mailing Address - Phone:646-320-0900
Mailing Address - Fax:
Practice Address - Street 1:9 LAKE BELLEVUE DR STE 214
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:425-215-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC610860281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical