Provider Demographics
NPI:1326792664
Name:FAIN, CRISTY MARIE (CO61132873)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:MARIE
Last Name:FAIN
Suffix:
Gender:F
Credentials:CO61132873
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 98TH ST S APT A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5976
Mailing Address - Country:US
Mailing Address - Phone:360-522-7570
Mailing Address - Fax:
Practice Address - Street 1:604 98TH ST S APT A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5976
Practice Address - Country:US
Practice Address - Phone:360-522-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61132873101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)