Provider Demographics
NPI:1407070188
Name:ADVOCATES FOR WELLNESS
Entity Type:Organization
Organization Name:ADVOCATES FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDP,CCDCII,CADC,
Authorized Official - Phone:509-783-8833
Mailing Address - Street 1:120 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3119
Mailing Address - Country:US
Mailing Address - Phone:509-783-8833
Mailing Address - Fax:509-783-0256
Practice Address - Street 1:120 VISTA WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3119
Practice Address - Country:US
Practice Address - Phone:509-783-8833
Practice Address - Fax:509-783-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA03-0444-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty