Provider Demographics
NPI:1902121288
Name:WILCOXEN, CARRIE ANN (COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:WILCOXEN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:WILCOXEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-8810
Mailing Address - Country:US
Mailing Address - Phone:425-258-4802
Mailing Address - Fax:425-252-0793
Practice Address - Street 1:2735 10TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1413
Practice Address - Country:US
Practice Address - Phone:425-258-4802
Practice Address - Fax:425-252-0793
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60147152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health