Provider Demographics
NPI:1376943217
Name:ITINA, MARINA (LMHCA)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:ITINA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:ITINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:2600 SW HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126
Mailing Address - Country:US
Mailing Address - Phone:206-512-4307
Mailing Address - Fax:
Practice Address - Street 1:2600 SW HOLDEN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126
Practice Address - Country:US
Practice Address - Phone:206-512-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60426367101YM0800X
WALH60700046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health