Provider Demographics
NPI:1821382870
Name:ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES
Entity Type:Organization
Organization Name:ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES
Other - Org Name:ASIAN COUNSELING TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAE
Authorized Official - Middle Name:SON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:253-302-3826
Mailing Address - Street 1:9100 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2427
Mailing Address - Country:US
Mailing Address - Phone:253-302-3826
Mailing Address - Fax:253-267-5212
Practice Address - Street 1:4629 168TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8640
Practice Address - Country:US
Practice Address - Phone:425-776-1290
Practice Address - Fax:425-776-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31130100251B00000X, 251S00000X, 261QR0405X, 251S00000X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2096846Medicaid