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General NPI Number Information
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NPI Number | 1720127095
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Entity Type | Organization
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Legal Business Name | CASCADE RECOVERY RESOURCE CENTER, LLC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 707 N PEARL ST SUITE D
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City | ELLENSBURG
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State | WA
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Zip | 98926-2938
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Country | US
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Telephone | 509-933-3838
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Fax | 509-933-4044
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Provider Business Mailing Address
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Address Line | 707 N PEARL ST SUITE D
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City | ELLENSBURG
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State | WA
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Zip | 98926-2938
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Country | US
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Telephone | 509-933-3838
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Fax | 509-933-4044
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | PAM STONEBURG
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Credential | CDP, NCACI
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Telephone | 509-933-3838
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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 | 602292
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License Number State | WA
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