Provider Demographics
NPI:1477108629
Name:VALLONE, CRISTINE ALEXA (CDPT)
Entity Type:Individual
Prefix:
First Name:CRISTINE
Middle Name:ALEXA
Last Name:VALLONE
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 W DEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1827
Mailing Address - Country:US
Mailing Address - Phone:509-415-8008
Mailing Address - Fax:
Practice Address - Street 1:910 W BOONE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5029
Practice Address - Country:US
Practice Address - Phone:509-325-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60982254101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)