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General NPI Number Information
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NPI Number | 1497265243
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Entity Type | Organization
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Legal Business Name | CHOICE WELLNESS CENTERS, LLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 1610 C STREET SUITE 102
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City | VANCOUVER
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State | WA
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Zip | 98663
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Country | US
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Telephone | 360-787-2125
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Fax | 360-787-2625
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Provider Business Mailing Address
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Address Line | 1610 C ST STE 102
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City | VANCOUVER
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State | WA
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Zip | 98663-3400
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Country | US
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Telephone | 360-787-2125
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Fax | 360-787-2625
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Authorized Official
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Title or Position | CEO
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Name | DR. ESTELA UY CLEMENTE
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Credential | PHARM.D.
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Telephone | 360-787-2902
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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 | CP60494259
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | MD60120618
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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