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Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Parent organization
NOOKSACK TRIBES GENESIS II
Other names
Nooksack Cabin Creek Youth Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
NOOKSACK TRIBES GENESIS II
Authorized official
MR. KEVIN COLLINS CCDCII, CHT (DIRECTOR OF TREATMENT SERVICES)
(360) 966-7704
Entity
Organization
Contact information
Practice address
3003 CABIN CREEK ROAD, EASTON, WA 98925
(425) 508-3967
Mailing address
PO BOX 157, DEMING, WA 98244-0157
(360) 966-7704
(360) 966-4225
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1993013
—
WA
Enumeration date
04/21/2010
Last updated
04/21/2010
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