Healthcare Provider Details

I. General information

NPI: 1518158922
Provider Name (Legal Business Name): MARINA V OLSEN MSC, CDP, NCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 RICE LN
ONALASKA WA
98570-9704
US

IV. Provider business mailing address

136 RICE LN
ONALASKA WA
98570-9704
US

V. Phone/Fax

Practice location:
  • Phone: 360-269-1266
  • Fax:
Mailing address:
  • Phone: 360-978-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00000167
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCG 60288871
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: