Provider Demographics
NPI:1063405926
Name:ANDERSON, CAROLE MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:MARIE
Other - Last Name:MICHALSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST
Mailing Address - Street 2:STE C-1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2461
Mailing Address - Country:US
Mailing Address - Phone:253-752-1860
Mailing Address - Fax:253-752-1890
Practice Address - Street 1:1919 N PEARL ST
Practice Address - Street 2:STE C-1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2461
Practice Address - Country:US
Practice Address - Phone:253-752-1860
Practice Address - Fax:253-752-1890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001431106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF00001431OtherLINCENSURE#