Provider Demographics
NPI:1346651098
Name:WELLMAN, CHRISTINA MARIE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-0541
Mailing Address - Country:US
Mailing Address - Phone:360-358-2085
Mailing Address - Fax:
Practice Address - Street 1:221 W RAILROAD AVE STE 2
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3507
Practice Address - Country:US
Practice Address - Phone:360-358-2085
Practice Address - Fax:360-485-4964
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60502687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2049887Medicaid
WA2155565Medicaid