Provider Demographics
NPI:1437496684
Name:EDGEWOOD SEATTLE ADDICTION SERVICES
Entity Type:Organization
Organization Name:EDGEWOOD SEATTLE ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC CDP
Authorized Official - Phone:206-402-4115
Mailing Address - Street 1:1200 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3543
Mailing Address - Country:US
Mailing Address - Phone:206-405-4115
Mailing Address - Fax:206-535-8207
Practice Address - Street 1:1200 WESTLAKE AVE N
Practice Address - Street 2:SUITE 508
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3543
Practice Address - Country:US
Practice Address - Phone:206-405-4115
Practice Address - Fax:206-535-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health