Provider Demographics
NPI:1003499195
Name:CENTER FOR JUSTICE SOCIAL WORK, INC.
Entity type:Organization
Organization Name:CENTER FOR JUSTICE SOCIAL WORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, DSW
Authorized Official - Phone:360-367-4284
Mailing Address - Street 1:524 N OLYMPIC AVE UNIT 453
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-0618
Mailing Address - Country:US
Mailing Address - Phone:425-346-0251
Mailing Address - Fax:
Practice Address - Street 1:3710 168TH ST NE STE A207
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8464
Practice Address - Country:US
Practice Address - Phone:360-218-4645
Practice Address - Fax:360-218-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty