Provider Demographics
NPI:1831724574
Name:EDMONDS COMMUNITY COLLEGE
Entity type:Organization
Organization Name:EDMONDS COMMUNITY COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR, COUNSELING/WELL
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNISKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-640-1718
Mailing Address - Street 1:20000 68TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5999
Mailing Address - Country:US
Mailing Address - Phone:425-640-1718
Mailing Address - Fax:
Practice Address - Street 1:20000 68TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5999
Practice Address - Country:US
Practice Address - Phone:425-640-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDMONDS COMMUNITY COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)