Provider Demographics
NPI:1366917015
Name:HOLM-MITCHELL, ROSEMARY (CDPT)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:HOLM-MITCHELL
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDPT
Mailing Address - Street 1:4730 180TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3603
Mailing Address - Country:US
Mailing Address - Phone:425-409-7504
Mailing Address - Fax:
Practice Address - Street 1:19201 120TH AVE NE STE 108
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9523
Practice Address - Country:US
Practice Address - Phone:425-485-6541
Practice Address - Fax:425-485-4154
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60557548101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)