Provider Demographics
NPI:1528189768
Name:ISLAND CENTER FOR COMPLEMENTARY MEDICINE INC P S
Entity Type:Organization
Organization Name:ISLAND CENTER FOR COMPLEMENTARY MEDICINE INC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HOUSEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:206-525-0750
Mailing Address - Street 1:6826 28TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7145
Mailing Address - Country:US
Mailing Address - Phone:206-525-0750
Mailing Address - Fax:206-524-6530
Practice Address - Street 1:840 SE BAYSHORE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4062
Practice Address - Country:US
Practice Address - Phone:360-679-0221
Practice Address - Fax:206-524-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003885101YA0400X, 101YM0800X
WAAC00000208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty