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General NPI Number Information
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NPI Number | 1831381342
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Entity Type | Organization
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Legal Business Name | LINCOLN COUNTY ALCOHOL DRUG CENTER
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 505 FIRST ST
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City | DAVENPORT
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State | WA
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Zip | 99122-0152
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Country | US
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Telephone | 509-725-2111
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Fax | 509-725-2141
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Provider Business Mailing Address
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Address Line | PO BOX 152
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City | DAVENPORT
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State | WA
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Zip | 99122-0152
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Country | US
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Telephone | 509-725-2111
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Fax | 509-725-2141
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DARREN MATTOZZI
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Credential |
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Telephone | 509-725-2111
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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 | CP00003123
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License Number State | WA
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