Provider Demographics
NPI:1619141173
Name:FLOURISH: A SPACE FOR DIMENSIONAL HEALING
Entity Type:Organization
Organization Name:FLOURISH: A SPACE FOR DIMENSIONAL HEALING
Other - Org Name:SUSAN MCCARTHY LAC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LLC
Authorized Official - Phone:360-798-7625
Mailing Address - Street 1:300 E 24TH ST.
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663
Mailing Address - Country:US
Mailing Address - Phone:360-798-7625
Mailing Address - Fax:360-529-0691
Practice Address - Street 1:300 E 24TH ST.
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663
Practice Address - Country:US
Practice Address - Phone:360-798-7625
Practice Address - Fax:360-529-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty