Provider Demographics
NPI:1518158922
Name:OLSEN, MARINA V (MSC, CDP, NCAC)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:V
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MSC, CDP, NCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 RICE LN
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-9704
Mailing Address - Country:US
Mailing Address - Phone:360-978-6989
Mailing Address - Fax:
Practice Address - Street 1:136 RICE LN
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570-9704
Practice Address - Country:US
Practice Address - Phone:360-269-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000167101YA0400X
WACG 60288871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)