Provider Demographics
NPI:1396138426
Name:AQUILINE COUNSELING, LLC
Entity type:Organization
Organization Name:AQUILINE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-914-0426
Mailing Address - Street 1:304 MAIN AVE S STE 301
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2758
Mailing Address - Country:US
Mailing Address - Phone:206-914-0426
Mailing Address - Fax:888-972-8305
Practice Address - Street 1:27010 190TH AVE SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-8486
Practice Address - Country:US
Practice Address - Phone:206-914-0426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60450981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty