Provider Demographics
NPI:1922860444
Name:SPITZ, MARINA R (SUDPT)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:R
Last Name:SPITZ
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20030 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7718
Mailing Address - Country:US
Mailing Address - Phone:206-288-9796
Mailing Address - Fax:
Practice Address - Street 1:20030 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7718
Practice Address - Country:US
Practice Address - Phone:206-288-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61264789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)