Provider Demographics
NPI:1205054053
Name:BENTON & FRANKLIN COUNTIES SUBSTANCE ABUSE ASSESSMENT CENTER
Entity type:Organization
Organization Name:BENTON & FRANKLIN COUNTIES SUBSTANCE ABUSE ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:509-735-2704
Mailing Address - Street 1:2635 W DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3004
Mailing Address - Country:US
Mailing Address - Phone:509-735-2704
Mailing Address - Fax:509-783-3355
Practice Address - Street 1:2635 W DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3004
Practice Address - Country:US
Practice Address - Phone:509-735-2704
Practice Address - Fax:509-783-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA03 0546 00251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health