Provider Demographics
NPI:1962667840
Name:CLARK, CHRISTINA E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:E
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:917 N 2ND ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3909
Mailing Address - Country:US
Mailing Address - Phone:206-651-4012
Mailing Address - Fax:888-974-1263
Practice Address - Street 1:917 N 2ND ST UNIT A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3909
Practice Address - Country:US
Practice Address - Phone:206-651-4012
Practice Address - Fax:888-974-1263
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD601399072084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry