Organization
EVERGREEN COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHIP DEITRICH CFO (CHEIF FINANCIAL OFFICER)
(360) 538-9227
Entity
Organization
Contact information
Practice address
205 8TH ST, HOQUIAM, WA 98550-2507
(360) 538-9227
(360) 532-8786
Mailing address
205 8TH ST, HOQUIAM, WA 98550-2507
(360) 538-9227
(360) 532-8786
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7067499
—
WA
Enumeration date
01/29/2007
Last updated
08/22/2020
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