Provider Demographics
NPI:1720640592
Name:DE ROCA, CHERYL (MA, MS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DE ROCA
Suffix:
Gender:
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 MILL CREEK BLVD STE 208A
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1737
Mailing Address - Country:US
Mailing Address - Phone:425-224-5233
Mailing Address - Fax:
Practice Address - Street 1:16300 MILL CREEK BLVD STE 208A
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1737
Practice Address - Country:US
Practice Address - Phone:425-224-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WALH61276727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional