Provider Demographics
NPI:1831958404
Name:THULL, ALICE ELAINE (LICSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ELAINE
Last Name:THULL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4973 WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9776
Mailing Address - Country:US
Mailing Address - Phone:360-341-4438
Mailing Address - Fax:
Practice Address - Street 1:4973 WHEEL DR
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9776
Practice Address - Country:US
Practice Address - Phone:360-221-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000086091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical