Individual
CARLA VAN DAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2620 RW JOHNSON BLVD SW SUITE 204, TUMWATER, WA 98501
(360) 956-0271
Mailing address
PO BOX 4453, TUMWATER, WA 98501-0453
(360) 956-0271
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00002218
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0364237
LABOR AND INDUSTRIES
WA
Enumeration date
11/08/2017
Last updated
06/16/2018
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