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Contact Information

TINA WIBSTAD, LCSW, LSSW, CADC III
906 MAIN AVE
TILLAMOOK, OR97141-3816
 Phone: 503-842-8201
 Fax: 503-815-1870
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Addiction (Substance Use Disorder)

101YA0400X
 

School

1041S0200X
Indicates primary specialty

NPI Profile & details for TINA WIBSTAD · (Female)

NPI Number 1518275130
Status Active
Credentials LCSW, LSSW, CADC III
Entity Individual
Enumeration date 09/16/2010
Last updated 04/04/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • OR License # 10517192
  • OR License # 12-06-70
  • OR License # L5975
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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