Provider Demographics
NPI:1679811152
Name:ROSTOM, MARLINE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:MARLINE
Middle Name:
Last Name:ROSTOM
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 MUKILTEO SPEEDWAY STE 204
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8490 MUKILTEO SPEEDWAY STE 204
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3210
Practice Address - Country:US
Practice Address - Phone:425-610-8484
Practice Address - Fax:425-698-2084
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60143626101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60335071OtherWA DEPARTMENT OF HEALTH