Provider Demographics
NPI:1215130166
Name:COMMUNITY COUNSELING INSTITIUTE
Entity type:Organization
Organization Name:COMMUNITY COUNSELING INSTITIUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-759-0852
Mailing Address - Street 1:PO BOX 5305
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0305
Mailing Address - Country:US
Mailing Address - Phone:253-759-0852
Mailing Address - Fax:253-752-0514
Practice Address - Street 1:2502 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1310
Practice Address - Country:US
Practice Address - Phone:253-759-0852
Practice Address - Fax:253-752-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27-0908-00174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1995422Medicaid