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General NPI Number Information
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NPI Number | 1467985440
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Entity Type | Individual
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Provider Name | MICHELE COSTA MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 181 PRIVATE PL
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City | FRIDAY HARBOR
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State | WA
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Zip | 98250-4801
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Country | US
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Telephone | 206-780-7988
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Fax |
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Provider Business Mailing Address
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Address Line | 19240 JENSEN WAY NE UNIT 2898
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City | POULSBO
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State | WA
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Zip | 98370-6294
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Country | US
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Telephone | 206-678-1440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60615068
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License Number State | WA
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