Provider Demographics
NPI:1497865737
Name:GIOVANNIELLO, COLETTE ANNETTE
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:ANNETTE
Last Name:GIOVANNIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 COMMERCE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3738
Mailing Address - Country:US
Mailing Address - Phone:360-703-7171
Mailing Address - Fax:
Practice Address - Street 1:1339 COMMERCE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3738
Practice Address - Country:US
Practice Address - Phone:360-703-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA910787084.101YA0400X
WALF 60125331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF 60125331OtherLICENSED MARRIAGE AND FAMILY THERAPIST
CALMF 47688,OtherLICENSED CLINICIAN MARRIAGE AND FAMILY THERAPIST