Provider Demographics
NPI:1366016313
Name:VERVITSIOTIS, CHRISTINE (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VERVITSIOTIS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20209 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7185
Mailing Address - Country:US
Mailing Address - Phone:425-775-4059
Mailing Address - Fax:
Practice Address - Street 1:7614 195TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6260
Practice Address - Country:US
Practice Address - Phone:425-775-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60897710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty