Healthcare Provider Details

I. General information

NPI: 1144664210
Provider Name (Legal Business Name): BELIEVE IN RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 TAYLOR ST SUITE 20
PORT TOWNSEND WA
98368-5753
US

IV. Provider business mailing address

211 TAYLOR ST SUITE 20
PORT TOWNSEND WA
98368-5753
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-1258
  • Fax: 360-385-1258
Mailing address:
  • Phone: 360-385-1258
  • Fax: 360-385-1258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16-1511-00
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number16-1511-00
License Number StateWA

VIII. Authorized Official

Name: MR. VINCENT LEONARD MARQUIS
Title or Position: OWNER/ADMINISTRATOR
Credential: CDP
Phone: 360-385-1258