Provider Demographics
NPI:1053125278
Name:CRISOSTOMO, NICOLLETTA E (CPC)
Entity type:Individual
Prefix:
First Name:NICOLLETTA
Middle Name:E
Last Name:CRISOSTOMO
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:NANCI
Other - Middle Name:E
Other - Last Name:HOMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPC
Mailing Address - Street 1:6926 NE FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7254
Mailing Address - Country:US
Mailing Address - Phone:360-768-6457
Mailing Address - Fax:
Practice Address - Street 1:6926 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7254
Practice Address - Country:US
Practice Address - Phone:360-993-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor