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General NPI Number Information
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NPI Number | 1750664835
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Entity Type | Organization
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Legal Business Name | CALM SPIRIT WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 09/24/2011
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Last Update Date | 09/24/2011
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Provider Practice Location Address
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Address Line | 16500 SE 15TH ST SUITE 160
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City | VANCOUVER
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State | WA
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Zip | 98683-9665
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Country | US
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Telephone | 360-607-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 SE GRACE AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-8376
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Country | US
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Telephone | 360-607-9580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES R DARLING
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Credential | LAC
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Telephone | 360-607-9580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | AC00003063
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License Number State | WA
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