Provider Demographics
NPI:1144289216
Name:HERALD, CHARAINE EMILY (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARAINE
Middle Name:EMILY
Last Name:HERALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 70TH AVENUE WEST
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-564-1193
Mailing Address - Fax:253-439-6222
Practice Address - Street 1:1919 70TH AVENUE WEST
Practice Address - Street 2:SUITE D-4
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-564-1193
Practice Address - Fax:253-439-6222
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7109739Medicaid
WA7109739Medicaid