Provider Demographics
NPI:1750427019
Name:THE VALLEY ALCOHOL COUNCIL, INC
Entity type:Organization
Organization Name:THE VALLEY ALCOHOL COUNCIL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:509-837-7700
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0997
Mailing Address - Country:US
Mailing Address - Phone:509-837-7700
Mailing Address - Fax:509-839-7311
Practice Address - Street 1:702 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2273
Practice Address - Country:US
Practice Address - Phone:509-837-7700
Practice Address - Fax:509-839-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600500889101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty