Provider Demographics
NPI:1598981771
Name:ELLIOTT, SAMUEL CHARLES (CADC-I)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CHARLES
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 NE 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1571
Mailing Address - Country:US
Mailing Address - Phone:360-450-1168
Mailing Address - Fax:
Practice Address - Street 1:4650 SW GRIFFITH DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8719
Practice Address - Country:US
Practice Address - Phone:503-684-8159
Practice Address - Fax:503-598-0934
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)