Healthcare Provider Details

I. General information

NPI: 1588184311
Provider Name (Legal Business Name): KRISTIN NICOLE WHITE CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LILLY RD NE STE C
OLYMPIA WA
98506-5080
US

IV. Provider business mailing address

2708 WESTMOOR CT SW
OLYMPIA WA
98502-5754
US

V. Phone/Fax

Practice location:
  • Phone: 360-918-8336
  • Fax: 360-972-2152
Mailing address:
  • Phone: 360-943-8810
  • Fax: 360-943-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: