Healthcare Provider Details

I. General information

NPI: 1710652359
Provider Name (Legal Business Name): ENRIQUE FERDINAND SANTIAGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 MARTIN WAY E
OLYMPIA WA
98506-5268
US

IV. Provider business mailing address

3857 MARTIN WAY E
OLYMPIA WA
98506-5268
US

V. Phone/Fax

Practice location:
  • Phone: 805-315-8315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1710652359
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: