Provider Demographics
NPI:1821642075
Name:WYNJA, CAROLYN N (CDPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:N
Last Name:WYNJA
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7682 SHILOHWOOD PL NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8947
Mailing Address - Country:US
Mailing Address - Phone:360-551-5728
Mailing Address - Fax:
Practice Address - Street 1:1415 LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9179
Practice Address - Country:US
Practice Address - Phone:360-876-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60960853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)