Healthcare Provider Details

I. General information

NPI: 1770866857
Provider Name (Legal Business Name): FULL CIRCLE COUNSELING AND RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2011
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 MOUNT BAKER RD STE B208
EASTSOUND WA
98245-8931
US

IV. Provider business mailing address

PO BOX 363
EASTSOUND WA
98245-0363
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-6181
  • Fax: 360-376-6182
Mailing address:
  • Phone: 360-376-6181
  • Fax: 360-376-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60026508
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP30006672
License Number StateWA

VIII. Authorized Official

Name: ANNE M. GRESHAM
Title or Position: REGISTERED AGENT
Credential: CNS, ARNP
Phone: 360-376-6181