| Providence Addictions Recovery Ctr | |
|
1800 Cooks Hill Rd Suite G Centralia WA 98531-9072 | |
| (360) 827-8200 | |
| (360) 827-8367 |
| Full Name | Providence Addictions Recovery Ctr |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 1800 Cooks Hill Rd, Centralia, Washington |
| Authorized Official Name and Position | Nicole Quinn (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Contact | 4255256715 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Addictions Recovery Ctr Po Box 34439 Seattle WA 98124-1439 Ph: (425) 525-6778 | Providence Addictions Recovery Ctr 1800 Cooks Hill Rd Suite G Centralia WA 98531-9072 Ph: (360) 827-8200 |
| NPI Number | 1124226360 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124226360 | NPI | - | NPPES |
| 15835 | Other | WA | CITY OF CHEHALIS BUSINESS |
| 602 399 531 | Other | WA | UBI MASTER LICENSE |
| 21 0354 00 | Medicaid | WA | CERT OF APPROVAL CHEM DEP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (Washington) | Primary |
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