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24437 Russell Rd Ste 230 Kent WA 98032-4950 | |
| (206) 816-2706 | |
| (253) 236-4107 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 24437 Russell Rd Ste 230, Kent, Washington |
| Authorized Official Name and Position | Adair Louise Hasty-vannoy (OWNER/ DIRECTOR) |
| Authorized Official Contact | 2068162706 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 59284 Renton WA 98058-2284 Ph: (206) 816-2706 | 24437 Russell Rd Ste 230 Kent WA 98032-4950 Ph: (206) 816-2706 |
| NPI Number | 1003206020 |
|---|---|
| Provider Enumeration Date | 01/29/2015 |
| Last Update Date | 07/27/2020 |
| Certification Date | 07/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003206020 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 603 152 746 (Washington) | Primary |
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