| NPI | 1164754404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA PEARL KNIGHT Clinical Supervisor 360-676-4485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA 37-038600) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2010-02-11 |