Provider Demographics
NPI:1174786792
Name:IRWIN, CAROL LOUISE (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LOUISE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 EASTGATE ST STE 140
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1589
Mailing Address - Country:US
Mailing Address - Phone:509-593-8122
Mailing Address - Fax:509-769-5221
Practice Address - Street 1:2330 EASTGATE ST STE 140
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-593-8122
Practice Address - Fax:509-769-5221
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60811024OtherLICSW