Provider Demographics
NPI:1356387310
Name:RICH, CHRISTINA PAULINE (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:PAULINE
Last Name:RICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4963 HELPPIE LN
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9314
Mailing Address - Country:US
Mailing Address - Phone:360-320-9969
Mailing Address - Fax:360-331-3829
Practice Address - Street 1:1121 SE DOCK ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4067
Practice Address - Country:US
Practice Address - Phone:360-320-9969
Practice Address - Fax:360-679-2777
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000087211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical