Provider Demographics
NPI:1770866857
Name:FULL CIRCLE COUNSELING AND RECOVERY, LLC
Entity Type:Organization
Organization Name:FULL CIRCLE COUNSELING AND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, ARNP
Authorized Official - Phone:360-376-6181
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0363
Mailing Address - Country:US
Mailing Address - Phone:360-376-6181
Mailing Address - Fax:360-376-6182
Practice Address - Street 1:1286 MOUNT BAKER RD STE B208
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8931
Practice Address - Country:US
Practice Address - Phone:360-376-6181
Practice Address - Fax:360-376-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60026508101YA0400X
WAAP30006672364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty