Provider Demographics
NPI:1366858219
Name:MICHALKE, MARISSA (LICSW, CDP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MICHALKE
Suffix:
Gender:F
Credentials:LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST
Mailing Address - Street 2:STE 301
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7206
Mailing Address - Country:US
Mailing Address - Phone:253-476-6500
Mailing Address - Fax:
Practice Address - Street 1:3629 S D ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-798-3593
Practice Address - Fax:253-798-2935
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608045111041C0700X
WACP60684686101YA0400X
WASC604899111041C0700X
WACO60491057101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical