Provider Demographics
NPI:1346776275
Name:THOMPSON, CHRISTINA (AAC MHCM)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:AAC MHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98577-3016
Mailing Address - Country:US
Mailing Address - Phone:360-942-2303
Mailing Address - Fax:360-942-5312
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-3016
Practice Address - Country:US
Practice Address - Phone:360-942-2303
Practice Address - Fax:360-942-5312
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60756886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health