Provider Demographics
NPI:1497097570
Name:GREEN, CHRISTINE B (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:GREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SE STONEMILL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6998
Mailing Address - Country:US
Mailing Address - Phone:360-816-2700
Mailing Address - Fax:360-816-2710
Practice Address - Street 1:315 SE STONEMILL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6998
Practice Address - Country:US
Practice Address - Phone:360-816-2700
Practice Address - Fax:360-816-2710
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist