Provider Demographics
NPI:1558964791
Name:RAINBOW CONNECTION PROFESSIONAL CLINICAL COUNSELOR SERVICE PC
Entity Type:Organization
Organization Name:RAINBOW CONNECTION PROFESSIONAL CLINICAL COUNSELOR SERVICE PC
Other - Org Name:RAINBOW CONNECTION COUNSELING COLLECTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, LPCC
Authorized Official - Phone:425-296-9793
Mailing Address - Street 1:300 LENORA ST # 616
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1223 CLEVELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3301
Practice Address - Country:US
Practice Address - Phone:425-296-9793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty