Provider Demographics
NPI:1881267573
Name:ROCHE, CAROLYN RACHELLE (LMHCA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RACHELLE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:RACHELLE
Other - Last Name:MERICLE-ROCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA
Mailing Address - Street 1:1855 TROSSACHS BLVD SE UNIT 2103
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-5928
Mailing Address - Country:US
Mailing Address - Phone:425-679-2268
Mailing Address - Fax:
Practice Address - Street 1:16150 NE 85TH ST STE 220
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3546
Practice Address - Country:US
Practice Address - Phone:425-558-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 221700000X
WA61145037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty