Provider Demographics
NPI:1083910590
Name:CALLENDER, KRISTINA NOEL (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NOEL
Last Name:CALLENDER
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 1:8928 28TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9340
Mailing Address - Country:US
Mailing Address - Phone:360-999-8467
Mailing Address - Fax:
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE UNIT A-16
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-999-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601887781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical