| Organization Name: | ISLAND CENTER FOR COMPLEMENTARY MEDICINE INC P S |
| NPI Number: | 1518081975 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBORAH ROSE HOUSEWORTH (PRESIDENT) |
| Mailing Address: | 220 1st St. Langley |
| State: | WA US |
| Postal Code: | 982600299 |
| Phone Number: | 3602217525 |
| Fax Number: | 2065246530 |
| NPI Enumeration Date: | 03/19/2007 |
| NPI Last Update Date: | 11/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LH00003885 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |