Provider Demographics
NPI:1306933650
Name:JONATHAN M. WAINWRIGHT MEMORIAL VA MEDICAL CENTER
Entity type:Organization
Organization Name:JONATHAN M. WAINWRIGHT MEMORIAL VA MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DARWIN
Authorized Official - Last Name:PREAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:509-525-5200
Mailing Address - Street 1:77 WAINWRIGHT DR
Mailing Address - Street 2:BUILDING 69 ROOM 230 A
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:
Mailing Address - Country:US
Mailing Address - Phone:509-525-5200
Mailing Address - Fax:509-527-3481
Practice Address - Street 1:77 WAINWRIGHT DR
Practice Address - Street 2:BUILDING 69 ROOM 230 A
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:509-527-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty