Provider Demographics
NPI:1730787763
Name:FOR THE CULTURE COUNSELING SERVICES
Entity type:Organization
Organization Name:FOR THE CULTURE COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:SUDP
Authorized Official - Phone:253-507-5334
Mailing Address - Street 1:4301 S PINE ST STE 92
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7259
Mailing Address - Country:US
Mailing Address - Phone:253-507-5334
Mailing Address - Fax:253-330-5182
Practice Address - Street 1:4301 S PINE ST STE 92
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7259
Practice Address - Country:US
Practice Address - Phone:206-383-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083180426Medicaid
WA1336686468Medicaid