Organization
JEFFERSON COMMUNITY COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA M FERGUSON (DIRECTOR OF OPERATIONS AND COMPLIAN)
(360) 385-0321
Entity
Organization
Contact information
Practice address
884 W PARK AVE, PORT TOWNSEND, WA 98368-2273
(360) 385-0321
(360) 379-2547
Mailing address
PO BOX 565, PORT TOWNSEND, WA 98368-0565
(360) 385-0321
(360) 379-2547
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7031917
—
WA
Enumeration date
10/10/2006
Last updated
02/07/2022
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