Provider Demographics
NPI:1063708469
Name:VABLAIS, CERISE MCKENNA (PHD)
Entity type:Individual
Prefix:DR
First Name:CERISE
Middle Name:MCKENNA
Last Name:VABLAIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3093
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-0093
Mailing Address - Country:US
Mailing Address - Phone:240-475-0886
Mailing Address - Fax:
Practice Address - Street 1:8290 165TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3948
Practice Address - Country:US
Practice Address - Phone:240-475-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04576103TC0700X
WATE60228917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical