Provider Demographics
NPI:1962627133
Name:TWIN, REUBEN C JR (CDP)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:C
Last Name:TWIN
Suffix:JR
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2506
Mailing Address - Country:US
Mailing Address - Phone:360-575-8275
Mailing Address - Fax:360-575-1950
Practice Address - Street 1:611 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2007
Practice Address - Country:US
Practice Address - Phone:206-324-9360
Practice Address - Fax:206-324-8910
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1993187Medicaid