Provider Demographics
NPI:1720590276
Name:MUNRO, GINA MARIA (SUDP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIA
Last Name:MUNRO
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7440 W MARGINAL WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4141
Mailing Address - Country:US
Mailing Address - Phone:206-470-3858
Mailing Address - Fax:206-470-3857
Practice Address - Street 1:27203 216TH AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:425-584-7570
Practice Address - Fax:425-584-7570
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60951619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)