Organization
CHILD AND ADOLESCENT CLINIC
Active
Parent organization
CHILD AND ADOLESCENT CLINIC
Other names
Child and Adolescent Clinic Health Homes
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILD AND ADOLESCENT CLINIC
Authorized official
CHELSAY PEDERSEN (CREDENTIALING SPECIALIST)
(360) 423-6140
Entity
Organization
Contact information
Practice address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 577-1771
Mailing address
971 11TH AVE, LONGVIEW, WA 98632-2503
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/26/2017
Last updated
05/26/2017
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