Organization
PROVIDENCE KODIAK ISLAND COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
717 E REZANOF DR, KODIAK, AK 99615-6416
(907) 481-2400
(907) 481-2419
Mailing address
PO BOX 3290, PORTLAND, OR 97208-3290
(907) 481-2000
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/15/2020
Last updated
05/15/2025
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