Provider Demographics
NPI:1063230621
Name:OLIVAREZ, ALINA ALYZAY
Entity type:Individual
Prefix:MISS
First Name:ALINA
Middle Name:ALYZAY
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 W DESCHUTES PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7719
Mailing Address - Country:US
Mailing Address - Phone:509-412-2675
Mailing Address - Fax:
Practice Address - Street 1:4315 DESERT PLATEAU DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9455
Practice Address - Country:US
Practice Address - Phone:509-412-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61591144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)