Individual
CHRISTYN DON MODICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4210 20TH ST E STE B&C, FIFE, WA 98424-1830
(253) 235-5216
Mailing address
1747 SW COZY LN, PORT ORCHARD, WA 98367-9321
(360) 536-0018
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61019299
WA
101Y00000X
Counselor
Primary
MC61140763
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60771150
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG61019299
COUNSELOR AGENCY AFFILIATED REGISTRATION
WA
Enumeration date
03/24/2020
Last updated
09/14/2021
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