Provider Demographics
NPI:1548756422
Name:MASON, CAROLYN RAE (MS, CDP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:RAE
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, CDP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:RAE
Other - Last Name:PAETOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4120 MERIDIAN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5575
Mailing Address - Country:US
Mailing Address - Phone:541-861-0400
Mailing Address - Fax:
Practice Address - Street 1:4120 MERIDIAN ST STE 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5575
Practice Address - Country:US
Practice Address - Phone:541-861-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60580897101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)