Provider Demographics
NPI:1871756494
Name:VITAL CHANGES TREATMENT, INC
Entity type:Organization
Organization Name:VITAL CHANGES TREATMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-336-4708
Mailing Address - Street 1:451 SW 10TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-336-4708
Mailing Address - Fax:425-336-2808
Practice Address - Street 1:451 SW 10TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-336-4708
Practice Address - Fax:425-336-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty