Provider Demographics
NPI:1881084473
Name:A CHANGE COUNSELING CENTER
Entity type:Organization
Organization Name:A CHANGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:982-708-9615
Mailing Address - Street 1:4002 S M ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-3800
Mailing Address - Country:US
Mailing Address - Phone:253-473-1844
Mailing Address - Fax:928-708-9620
Practice Address - Street 1:4002 S M ST
Practice Address - Street 2:SUITE C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-3800
Practice Address - Country:US
Practice Address - Phone:253-473-1844
Practice Address - Fax:928-708-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27125700261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder