Provider Demographics
NPI:1790380335
Name:SAND, CHRISTINA (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SAND
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 1:600 OAKESDALE AVE SW STE 104
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5226
Mailing Address - Country:US
Mailing Address - Phone:425-228-5336
Mailing Address - Fax:425-228-4540
Practice Address - Street 1:600 OAKESDALE AVE SW STE 104
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5226
Practice Address - Country:US
Practice Address - Phone:425-228-5336
Practice Address - Fax:425-228-4540
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66950781104100000X
WALW669507811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical