Provider Demographics
NPI:1124607791
Name:EARL, ROSEMARIE JANEAN (LMHCA)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:JANEAN
Last Name:EARL
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:EARL-KOLEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA
Mailing Address - Street 1:9711 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2309
Mailing Address - Country:US
Mailing Address - Phone:206-660-4839
Mailing Address - Fax:
Practice Address - Street 1:9711 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2309
Practice Address - Country:US
Practice Address - Phone:206-660-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60961537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC60961537OtherDEPARTMENT OF LICENSING