| NPI | 1245438738 |
|---|---|
| Doing Business As | PROVIDENCE ADDICTIONS RECOVERY CTR |
| Entity Type | Organization |
| Authorized Contact | NICOLE QUINN Payor Credentialing Manager 425-525-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2010-12-22 |