| Community Counseling Clinic Llc | |
|
2642 Main St Union Gap WA 98903-1752 | |
| (509) 452-6546 | |
| (509) 452-6965 |
| Full Name | Community Counseling Clinic Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2642 Main St, Union Gap, Washington |
| Authorized Official Name and Position | Carolyn Kay Fries (ADMINISTRATOR SR MEMBER) |
| Authorized Official Contact | 5094526546 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Counseling Clinic Llc Po Box 3036 Union Gap WA 98903-0036 Ph: (509) 452-6546 | Community Counseling Clinic Llc 2642 Main St Union Gap WA 98903-1752 Ph: (509) 452-6546 |
| NPI Number | 1942337076 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942337076 | NPI | - | NPPES |
| 7500CO | Other | WA | REGENCE BLUE SHIELD |
| CP00002903 | Other | WA | DARRELL G FRIES CDP |
| A7570 | Other | WA | PREMERA BLUE CROSS |
| 1995448 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (Washington) | Primary |