Healthcare Provider Details

I. General information

NPI: 1477751808
Provider Name (Legal Business Name): CHRISTINE MARIE MITCHELL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PACIFIC AVE
TACOMA WA
98418-7915
US

IV. Provider business mailing address

5858 SE LAKE VALLEY RD
PORT ORCHARD WA
98367
US

V. Phone/Fax

Practice location:
  • Phone: 253-798-4609
  • Fax:
Mailing address:
  • Phone: 360-874-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: