Provider Demographics
NPI: | 1780856906 |
---|---|
Name: | CLEARWATER COUNSELING |
Entity Type: | Organization |
Organization Name: | CLEARWATER COUNSELING |
Other - Org Name: | ALESIA BLACK |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALESIA |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | BLACK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | ARNP |
Authorized Official - Phone: | 253-300-0394 |
Mailing Address - Street 1: | 5224 OLYMPIC DR STE 214 |
Mailing Address - Street 2: | |
Mailing Address - City: | GIG HARBOR |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98335-1792 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-300-0394 |
Mailing Address - Fax: | 253-313-0570 |
Practice Address - Street 1: | 5224 OLYMPIC DR STE 214 |
Practice Address - Street 2: | |
Practice Address - City: | GIG HARBOR |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98335-1792 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-300-0394 |
Practice Address - Fax: | 253-313-0570 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-03-27 |
Last Update Date: | 2021-12-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |