1780838912 NPI number — DR. CHRISTINE KATE EASTMAN PSY.D, LCSW

Table of content: DEIONDRIA WILLIAMS (NPI 1700523289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780838912 NPI number — DR. CHRISTINE KATE EASTMAN PSY.D, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASTMAN
Provider First Name:
CHRISTINE
Provider Middle Name:
KATE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EASTMAN
Provider Other First Name:
KATE
Provider Other Middle Name:
SWAIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D, LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780838912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6134 PARKSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-4092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-749-1392
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 SKYLINE WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221-2992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-749-1392
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW60234810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)