Provider Demographics
NPI:1942785407
Name:THOMPSON, CRYSTALIN RENNEE (SUDP)
Entity Type:Individual
Prefix:
First Name:CRYSTALIN
Middle Name:RENNEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 112TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-5307
Mailing Address - Country:US
Mailing Address - Phone:954-323-2750
Mailing Address - Fax:954-323-2750
Practice Address - Street 1:5001 112TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-5307
Practice Address - Country:US
Practice Address - Phone:954-323-2750
Practice Address - Fax:954-323-2794
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60940324OtherSUBSTANCE USE DISORDER COUNSELOR
WACO60776673OtherCHEMICAL DEPENDENCY COUNSELOR INTERN