Provider Demographics
NPI:1578214508
Name:FULL CONTACT RECOVERY SUPPORT SERVICES
Entity Type:Organization
Organization Name:FULL CONTACT RECOVERY SUPPORT SERVICES
Other - Org Name:CONTACT COUNSELING RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:SUDPT
Authorized Official - Phone:360-393-7970
Mailing Address - Street 1:316 E MCLEOD RD
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6491
Mailing Address - Country:US
Mailing Address - Phone:360-671-3277
Mailing Address - Fax:360-733-9499
Practice Address - Street 1:316 E MCLEOD RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6491
Practice Address - Country:US
Practice Address - Phone:360-671-3277
Practice Address - Fax:360-733-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABHA.FS.61179158Medicaid