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General NPI Number Information
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NPI Number | 1487177143
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Entity Type | Organization
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Legal Business Name | UKRAINIAN COMMUNITY CENTER OF WASHINGTON
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 13470 MARTIN LUTHER KING JR WAY S
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City | SEATTLE
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State | WA
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Zip | 98178-5210
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Country | US
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Telephone | 425-430-8229
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Fax | 425-336-2785
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Provider Business Mailing Address
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Address Line | 17701 108TH AVE SE # 336
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City | RENTON
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State | WA
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Zip | 98055-6448
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Country | US
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Telephone | 425-430-8229
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Fax | 425-336-2785
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Authorized Official
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Title or Position | DEPUTY EXECUTIVE DIRECTOR
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Name | ANDREW OREST KRITOVICH
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Credential | LMHC
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Telephone | 425-430-8229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 200132
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License Number State | WA
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