| Providence Addictions Recovery Ctr | |
|
1322 Commerce Ave Longview WA 98632-3718 | |
| (360) 414-8771 | |
| (360) 414-8776 |
| Full Name | Providence Addictions Recovery Ctr |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 1322 Commerce Ave, Longview, 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 1322 Commerce Ave Longview WA 98632-3718 Ph: (360) 414-8771 |
| NPI Number | 1245438738 |
|---|---|
| Provider Enumeration Date | 07/05/2007 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245438738 | NPI | - | NPPES |
| 08 0983 00 | Medicaid | WA | |
| 631762 | Other | WA | LONGVIEW BUSINESS LICENSE |
| 602 399 531 | Other | WA | UBI MASTER LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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