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General NPI Number Information
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NPI Number | 1407070188
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Entity Type | Organization
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Legal Business Name | ADVOCATES FOR WELLNESS
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 120 VISTA WAY
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City | KENNEWICK
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State | WA
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Zip | 99336-3119
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Country | US
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Telephone | 509-783-8833
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Fax | 509-783-0256
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Provider Business Mailing Address
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Address Line | 120 VISTA WAY
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City | KENNEWICK
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State | WA
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Zip | 99336-3119
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Country | US
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Telephone | 509-783-8833
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Fax | 509-783-0256
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | PAUL DEAN JORGENSON
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Credential | CDP,CCDCII,CADC,
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Telephone | 509-783-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 03-0444-00
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License Number State | WA
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