Provider Demographics
NPI:1316243033
Name:ACCOLA, KATIE JOY (MA)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:JOY
Last Name:ACCOLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 RAILROAD AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-7207
Mailing Address - Country:US
Mailing Address - Phone:425-941-7495
Mailing Address - Fax:
Practice Address - Street 1:144 RAILROAD AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-7207
Practice Address - Country:US
Practice Address - Phone:425-941-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60560868101YM0800X
WAMG60293007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANC10041359OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WAMC60560868OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WAMG60293007OtherWASHINGTON STATE DEPARTMENT OF HEALTH