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4400 Ne 77th Ave Ste 275 Vancouver WA 98662-6857 | |
| (564) 218-4512 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Pastoral |
| Location | 4400 Ne 77th Ave Ste 275, Vancouver, Washington |
| Authorized Official Name and Position | Violet Ione Kashewa (PRESIDENT) |
| Authorized Official Contact | 5642184512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4400 Ne 77th Ave Ste 275 Vancouver WA 98662-6857 Ph: (564) 218-4512 | 4400 Ne 77th Ave Ste 275 Vancouver WA 98662-6857 Ph: (564) 218-4512 |
| NPI Number | 1538927322 |
|---|---|
| Provider Enumeration Date | 03/07/2024 |
| Last Update Date | 07/23/2024 |
| Certification Date | 07/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538927322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP1600X | Counselor - Pastoral | (* (Not Available)) | Primary |
| 251B00000X | Case Management | (* (Not Available)) | Secondary |
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