Healthcare Provider Details

I. General information

NPI: 1861333239
Provider Name (Legal Business Name): PINE TREE PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 28TH ST NE
LAKE STEVENS WA
98258-6497
US

IV. Provider business mailing address

8430 28TH ST NE
LAKE STEVENS WA
98258-6497
US

V. Phone/Fax

Practice location:
  • Phone: 425-307-5599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AGNIESZKA LINIEWIECKA-DZIWOK
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 847-454-4219