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?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)