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Organization
FREEDOM RECOVERY CENTER LLC
Active
Organization
FREEDOM RECOVERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT W LONG COUNSELOR (PROVIDER/OWNER)
(253) 862-7374
Entity
Organization
Contact information
Practice address
10215 214TH AVE E, BONNEY LAKE, WA 98391-3909
(253) 862-7374
(253) 862-0448
Mailing address
10215 214TH AVE E, BONNEY LAKE, WA 98391-3909
(253) 862-7374
(253) 862-0448
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP0002606
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP00002606
COUNSELOR REGISTRATION
WA
Enumeration date
07/23/2009
Last updated
02/28/2013
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