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NPI Code Detail

MEDICARE: CATHOLIC COMMUNITY SERVICES WESTERN WASHINGTON

MEDICARE: CATHOLIC COMMUNITY SERVICES WESTERN WASHINGTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center37078600WA

General Provider Information

NPI Number : 1396817375
Entity Type Code : Organization
Provider Name (Legal Business Name) : CATHOLIC COMMUNITY SERVICES WESTERN WASHINGTON
Provider Business Mailing Address
First Line : 515 LAKEWAY DR
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-5233
Country : US
Telephone Number : 360-676-2187
Fax Number : 360-676-2162
Provider Business Practice Location Address
First Line : 515 LAKEWAY DR
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-5233
Country : US
Telephone Number : 360-676-2187
Fax Number : 360-676-2162
Authorized Official
Title or Position : DIRECTOR
Name : MS. DONNA M WELLS
Credential : MA, CDP
Telephone Number : 360-676-2187
Provider Enumeration Date : 11/14/2006
Last Update Date : 05/14/2014

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Practice Location Address:
515 LAKEWAY DR
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98225-5233
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1568528743 — MARK ROBERT WARD SUDP
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1992991376 — MARGRET ANGELA KAVANAGH LMT, SUDP
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Practice Fax:
1952621716 — BRIYANA NICOLE ANDERSON CDPT
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1225343007 — SHANNON MARIE SEXTON
Practice Location Address:
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1134480320 — MS. MEGHAN ELIZABETH LEVER CDP-T
Practice Location Address:
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Practice Fax: 360-676-2162

Directions to “CATHOLIC COMMUNITY SERVICES WESTERN WASHINGTON ” Practice Location

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