Organization
COMMUNITY HOUSE ON BROADWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAMERON CARSON (CLINIC MANAGER)
(360) 200-5419
Entity
Organization
Contact information
Practice address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
Mailing address
PO BOX 403, LONGVIEW, WA 98632-7260
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
313
WA
Other
Enumeration date
10/06/2014
Last updated
10/06/2015
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