| Organization Name: | JEFFERSON COMMUNITY COUNSELING CENTER |
| NPI Number: | 1083701015 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TONYA FERGUSON (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 884 W Park Ave Port Townsend |
| State: | WA US |
| Postal Code: | 983682273 |
| Phone Number: | 3603850321 |
| Fax Number: | 3603792547 |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 01/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 601357458 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |