| NPI | 1235759879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JA-ANGEL DEWALT Billing Specialist Lead 360-377-3776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2020-04-23 |