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General NPI Number Information
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NPI Number | 1770866857
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE COUNSELING AND RECOVERY, 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 | 1286 MOUNT BAKER RD STE B208
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City | EASTSOUND
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State | WA
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Zip | 98245-8931
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Country | US
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Telephone | 360-376-6181
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Fax | 360-376-6182
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Provider Business Mailing Address
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Address Line | PO BOX 363
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City | EASTSOUND
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State | WA
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Zip | 98245-0363
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Country | US
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Telephone | 360-376-6181
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Fax | 360-376-6182
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | ANNE M. GRESHAM
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Credential | CNS, ARNP
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Telephone | 360-376-6181
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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 | CP60026508
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | AP30006672
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License Number State | WA
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