Healthcare Provider Details

I. General information

NPI: 1891073813
Provider Name (Legal Business Name): SEXUAL ASSAULT CENTER OF PIERCE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N MILDRED ST STE J
TACOMA WA
98406-1725
US

IV. Provider business mailing address

633 N MILDRED ST STE J
TACOMA WA
98406-1725
US

V. Phone/Fax

Practice location:
  • Phone: 253-597-6424
  • Fax: 253-597-6443
Mailing address:
  • Phone: 253-597-6424
  • Fax: 253-597-6443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TASHA CHURCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 253-597-6424