Provider Demographics
NPI:1629724117
Name:MASON, KATRINA CLAUDIA-LEE (SUDP-T)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:CLAUDIA-LEE
Last Name:MASON
Suffix:
Gender:F
Credentials:SUDP-T
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:CLAUDIA-LEE
Other - Last Name:DIGBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUDP-T
Mailing Address - Street 1:8649 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5812
Mailing Address - Country:US
Mailing Address - Phone:360-515-0422
Mailing Address - Fax:360-915-9488
Practice Address - Street 1:8649 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5812
Practice Address - Country:US
Practice Address - Phone:360-515-0422
Practice Address - Fax:360-915-9488
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61049531101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)