Provider Demographics
NPI:1801009394
Name:SPICER, KRISTINA HEIDI (CDP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:HEIDI
Last Name:SPICER
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6116
Mailing Address - Country:US
Mailing Address - Phone:360-927-1829
Mailing Address - Fax:
Practice Address - Street 1:2806 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6930
Practice Address - Country:US
Practice Address - Phone:360-676-2187
Practice Address - Fax:360-676-2162
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001834101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)