Provider Demographics
NPI:1649647306
Name:FINE, MIA (MS LMFTA)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:MS LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 N 34TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9058
Mailing Address - Country:US
Mailing Address - Phone:561-203-9087
Mailing Address - Fax:
Practice Address - Street 1:1914 N 34TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9058
Practice Address - Country:US
Practice Address - Phone:561-203-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60580255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist