Provider Demographics
NPI:1952678831
Name:CALDWELL, CHRISTINE TUPPER (LICSW, CDP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:TUPPER
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 EASTLAKE AVE E STE 100B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3801
Mailing Address - Country:US
Mailing Address - Phone:206-323-4750
Mailing Address - Fax:206-323-9563
Practice Address - Street 1:3123 EASTLAKE AVE E STE 100B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3801
Practice Address - Country:US
Practice Address - Phone:206-323-4750
Practice Address - Fax:206-323-9563
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00001326101YA0400X
WALW 600857871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603-133-355OtherUBI