Provider Demographics
NPI:1073196325
Name:WHITE, CHRISTY DAWN
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DAWN
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E H ST STE F
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-7130
Mailing Address - Country:US
Mailing Address - Phone:509-276-7768
Mailing Address - Fax:833-281-1582
Practice Address - Street 1:11 E H ST STE F
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7130
Practice Address - Country:US
Practice Address - Phone:509-276-7768
Practice Address - Fax:833-281-1582
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA83-2716746Medicaid