Provider Demographics
NPI:1154801538
Name:GREEN, CHRISTIE (CDP, LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CDP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 NW RANDALL WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7847
Mailing Address - Country:US
Mailing Address - Phone:360-698-5883
Mailing Address - Fax:360-809-6002
Practice Address - Street 1:3888 NW RANDALL WAY STE 201
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7847
Practice Address - Country:US
Practice Address - Phone:360-698-5883
Practice Address - Fax:360-809-6002
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61469152101YM0800X
WACO60876664101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2110002Medicaid