1083853501 NPI number — MS. DARCIA CARLLETTE TUDOR MA, CMHS, WCM, JD

Table of content: MS. DARCIA CARLLETTE TUDOR MA, CMHS, WCM, JD (NPI 1083853501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083853501 NPI number — MS. DARCIA CARLLETTE TUDOR MA, CMHS, WCM, JD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUDOR
Provider First Name:
DARCIA
Provider Middle Name:
CARLLETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, CMHS, WCM, JD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OWINGS
Provider Other First Name:
DARCIA CARLETTE
Provider Other Middle Name:
CARLLETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
JD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083853501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2018 156TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98007-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-547-3166
Provider Business Mailing Address Fax Number:
425-883-4751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2018 156TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-3825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-3166
Provider Business Practice Location Address Fax Number:
425-883-4751
Provider Enumeration Date:
02/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  12175 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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