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Organization

A CHANGE COUNSELING CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN LEDOUX (FACILITY COORDINATOR)
(982) 708-9615
Entity
Organization

Contact information

Practice address
4002 S M ST, SUITE C, TACOMA, WA 98418-3800
(253) 473-1844
(928) 708-9620
Mailing address
4002 S M ST, SUITE C, TACOMA, WA 98418-3800
(253) 473-1844
(928) 708-9620

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
27125700
WA

Other

Enumeration date
02/03/2015
Last updated
02/03/2015
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