| Organization Name: | COMMUNITY COUNSELING CLINIC LLC |
| NPI Number: | 1942337076 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROLYN KAY FRIES (ADMINISTRATOR SR MEMBER) |
| Mailing Address: | 2642 Main St Union Gap |
| State: | WA US |
| Postal Code: | 989031752 |
| Phone Number: | 5094526546 |
| Fax Number: | 5094526965 |
| NPI Enumeration Date: | 02/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |