Healthcare Provider Details

I. General information

NPI: 1942147327
Provider Name (Legal Business Name): EVERGREEN HEALING TOUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8407 NE 334TH ST
LA CENTER WA
98629-2822
US

IV. Provider business mailing address

8407 NE 334TH ST
LA CENTER WA
98629-2822
US

V. Phone/Fax

Practice location:
  • Phone: 360-936-9138
  • Fax:
Mailing address:
  • Phone: 360-936-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELE DIPOLITO-MCCARTY
Title or Position: OWNER/OPERATOR/LMT
Credential: LMT, HHP
Phone: 360-936-9138