Doctor Name: | REGINA A BLACKWOLF |
NPI Number: | 1184777252 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, LICSW |
License Number: | CP00005962 |
Business Practice Address: | 5803 232nd St Sw Suite 4 Mountlake Terrace, WA - 980434637 |
Business Phone Number: | 2063757657 |
Business Fax Number: | 2063195325 |
Mailing Address: | 5803 232nd St Sw, Suite 4 MOUNTLAKE TERRACE |
State: | WA |
Postal Code: | 980434637 |
Phone Number: | 2063757657 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2007 |
NPI Last Update Date: | 03/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CP00005962 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |