Healthcare Provider Details

I. General information

NPI: 1235606047
Provider Name (Legal Business Name): KATRINA LAINE DAILY MSW/CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATRINA LAINE RUSSELL

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E SHORT AVE
SPOKANE WA
99202-1555
US

IV. Provider business mailing address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax:
Mailing address:
  • Phone: 509-838-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60456610
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00006091
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61018956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: