Provider Demographics
NPI:1073705075
Name:COYLE, KRISTINA D (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:D
Last Name:COYLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 GROVE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4491
Mailing Address - Country:US
Mailing Address - Phone:425-344-9722
Mailing Address - Fax:
Practice Address - Street 1:5019 GROVE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4487
Practice Address - Country:US
Practice Address - Phone:425-344-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601858901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical