Healthcare Provider Details

I. General information

NPI: 1578578373
Provider Name (Legal Business Name): CHRISTINA P. RICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 SE DOCK ST
OAK HARBOR WA
98277-4067
US

IV. Provider business mailing address

PO BOX 483
TOKELAND WA
98590-0483
US

V. Phone/Fax

Practice location:
  • Phone: 360-581-9028
  • Fax: 360-679-2777
Mailing address:
  • Phone: 360-581-9028
  • Fax: 360-679-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00008721
License Number StateWA

VIII. Authorized Official

Name: CHRISTINA PAULINE RICH
Title or Position: OWNER
Credential: LICSW
Phone: 360-320-9969