Provider Demographics
NPI:1407335623
Name:CHRISTENSON, MARGUERITE GLORY ANNA (CDP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:GLORY ANNA
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCCLEARY
Mailing Address - State:WA
Mailing Address - Zip Code:98557-9614
Mailing Address - Country:US
Mailing Address - Phone:509-952-9791
Mailing Address - Fax:
Practice Address - Street 1:8645 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5851
Practice Address - Country:US
Practice Address - Phone:360-515-0070
Practice Address - Fax:360-915-6792
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61109039OtherWASHINGTON STATE DEPARTMENT OF HEALTH