| Columbia Wellness | |
|
720 14th Avenue Longview WA 98632-2316 | |
| (360) 423-0203 | |
| (360) 423-5086 |
| Full Name | Columbia Wellness |
|---|---|
| Speciality | Case Management |
| Location | 720 14th Avenue, Longview, Washington |
| Authorized Official Name and Position | Joseph Andrew Mcdaniel (CEO) |
| Authorized Official Contact | 3604230203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Wellness Po Box 1847 Longview WA 98632-8140 Ph: (360) 423-0203 | Columbia Wellness 720 14th Avenue Longview WA 98632-2316 Ph: (360) 423-0203 |
| NPI Number | 1487659579 |
|---|---|
| Provider Enumeration Date | 06/16/2005 |
| Last Update Date | 04/19/2022 |
| Certification Date | 04/19/2022 |
| Medicare PECOS PAC ID | 2567358286 |
|---|---|
| Medicare Enrollment ID | O20040227000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487659579 | NPI | - | NPPES |
| 1980903 | Medicaid | WA |
| Provider Name | Sophie M Hoptowit |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821159492 PECOS PAC ID: 0840399259 Enrollment ID: I20080723000188 |
| Provider Name | Cesar P Rafano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841342284 PECOS PAC ID: 9931369493 Enrollment ID: I20120321000417 |
| Provider Name | Harrison H Detroja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154670628 PECOS PAC ID: 9739338245 Enrollment ID: I20121130000424 |
| Provider Name | David J Paris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073666848 PECOS PAC ID: 8729217948 Enrollment ID: I20140211001871 |
| Provider Name | Joseph Andrew Mcdaniel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861551012 PECOS PAC ID: 0042646242 Enrollment ID: I20200206002266 |
| Provider Name | Christina Lee Floyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255466470 PECOS PAC ID: 5799135430 Enrollment ID: I20231221001827 |
| Provider Name | David I Dropkin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124148911 PECOS PAC ID: 0345690418 Enrollment ID: I20240102002660 |
| Provider Name | Valorie Michele Futcher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619017746 PECOS PAC ID: 2365892353 Enrollment ID: I20240103003210 |
| Provider Name | Kathy Ann Ryan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972955037 PECOS PAC ID: 1153772116 Enrollment ID: I20240116002943 |
| Provider Name | Jolivia J Porter |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1639315179 PECOS PAC ID: 4789036583 Enrollment ID: I20240117002759 |
| Provider Name | Joshua Bitton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215410089 PECOS PAC ID: 7911350475 Enrollment ID: I20240131003070 |
| Provider Name | Joshua Aaron Sandaker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346916665 PECOS PAC ID: 9931544301 Enrollment ID: I20240226003098 |
| Provider Name | Jessica Marie Shook |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861531048 PECOS PAC ID: 6406384338 Enrollment ID: I20250106003591 |
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