Provider Demographics
NPI:1285182543
Name:GARCIA, TRISTA (CDPT)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:
Other - Last Name:GRONNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 188TH ST SW APT 20
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-7624
Mailing Address - Country:US
Mailing Address - Phone:425-239-8860
Mailing Address - Fax:
Practice Address - Street 1:1227 2ND ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4906
Practice Address - Country:US
Practice Address - Phone:360-651-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)