Healthcare Provider Details

I. General information

NPI: 1154410876
Provider Name (Legal Business Name): MADRONA INSTITUTE OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 W PARK AVE
PORT TOWNSEND WA
98368-2273
US

IV. Provider business mailing address

PO BOX 1745
PORT TOWNSEND WA
98368-0179
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-0321
  • Fax: 360-385-3944
Mailing address:
  • Phone: 360-385-0321
  • Fax: 360-385-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateWA

VIII. Authorized Official

Name: LAURIE STRONG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-385-0321