Provider Demographics
NPI:1013109966
Name:EASTSIDE ADDICTION PROFESSIONALS
Entity Type:Organization
Organization Name:EASTSIDE ADDICTION PROFESSIONALS
Other - Org Name:EASTSIDE CENTER FOR FAMILY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-462-8558
Mailing Address - Street 1:2025 112TH AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2959
Mailing Address - Country:US
Mailing Address - Phone:206-604-0939
Mailing Address - Fax:
Practice Address - Street 1:1450 114TH AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6962
Practice Address - Country:US
Practice Address - Phone:425-462-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17109700101YA0400X
WALH00010662101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty