Provider Demographics
NPI:1861794760
Name:ETHERINGTON, CARRIE CRISTINA
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:CRISTINA
Last Name:ETHERINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0959
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:406-234-4039
Practice Address - Street 1:2715 SAINT ANDREWS LOOP STE D
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3386
Practice Address - Country:US
Practice Address - Phone:509-575-4084
Practice Address - Fax:406-234-4039
Is Sole Proprietor?:No
Enumeration Date:2010-11-27
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1249101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)