Provider Demographics
NPI:1831550029
Name:MAYBERRY-ABE, JC (LMHC)
Entity type:Individual
Prefix:
First Name:JC
Middle Name:
Last Name:MAYBERRY-ABE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JONNALI
Other - Middle Name:
Other - Last Name:MAYBERRY-ABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:11460 69TH PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-3001
Mailing Address - Country:US
Mailing Address - Phone:206-790-7366
Mailing Address - Fax:
Practice Address - Street 1:4501 15TH AVE S
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1873
Practice Address - Country:US
Practice Address - Phone:206-790-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60547886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health