Organization
KLLALLAM COUSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN D COLLINS CB00017145 (ADMINISTRATOR)
(360) 452-4432
Entity
Organization
Contact information
Practice address
1026 EAST FRONT ST., #2, PORT ANGELES, WA 98362
(360) 452-4432
(360) 452-4599
Mailing address
73 NISBET RD, SEQU, SEQUIM, WA 98382-7314
(360) 681-8092
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
CP00004528
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CP00004528
—
WA
Enumeration date
11/16/2011
Last updated
11/16/2011
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