Provider Demographics
NPI:1932190410
Name:TOMPKINS, STEPHANIE (CDP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 4TH AVE E STE 301
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1188
Mailing Address - Country:US
Mailing Address - Phone:360-357-7986
Mailing Address - Fax:360-534-9595
Practice Address - Street 1:203 4TH AVE E STE 301
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-357-7986
Practice Address - Fax:360-534-9595
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60165453101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126370Medicaid