Provider Demographics
NPI:1487998217
Name:PENDLETON, CAROL ANNE (LMFTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11718 ARROW POINT DR NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1425
Mailing Address - Country:US
Mailing Address - Phone:206-355-8532
Mailing Address - Fax:
Practice Address - Street 1:11718 ARROW POINT DR NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1425
Practice Address - Country:US
Practice Address - Phone:206-355-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60307219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist