Healthcare Provider Details

I. General information

NPI: 1619772282
Provider Name (Legal Business Name): TONI PRINCIPE LICSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 STATE AVE NE
OLYMPIA WA
98506-6514
US

IV. Provider business mailing address

1910 EAST 4TH AVE PMB 35
OLYMPIA WA
98506-4632
US

V. Phone/Fax

Practice location:
  • Phone: 360-297-0660
  • Fax: 306-515-4753
Mailing address:
  • Phone: 360-207-0660
  • Fax: 306-515-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONI JO PRINCIPE
Title or Position: LICSW/OWNER
Credential: LICSW
Phone: 360-250-1134