Individual
TINA M OVERSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDP
Contact information
Practice address
803 S MAIN ST STE 120, MOSCOW, ID 83843-2695
(509) 444-8200
Mailing address
611 N IRON BRIDGE WAY, SPOKANE, WA 99202-4932
(509) 444-8200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000001
ST OF WA
WA
Enumeration date
07/17/2013
Last updated
04/15/2022
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