Provider Demographics
NPI:1487029708
Name:BHARDRA RECOVERY
Entity Type:Organization
Organization Name:BHARDRA RECOVERY
Other - Org Name:CTC COUNSELING SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:DARK
Authorized Official - Suffix:
Authorized Official - Credentials:SUDD
Authorized Official - Phone:206-957-0721
Mailing Address - Street 1:18500 156TH AVE NE
Mailing Address - Street 2:#300
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:206-957-0721
Mailing Address - Fax:206-957-0723
Practice Address - Street 1:18500 156TH AVE NE
Practice Address - Street 2:#300
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:206-957-0721
Practice Address - Fax:206-957-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17 113800261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder