Provider Demographics
NPI:1588105506
Name:FORCA COUNSELING
Entity type:Organization
Organization Name:FORCA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC MHP CMHS
Authorized Official - Phone:425-351-1059
Mailing Address - Street 1:8106 35TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3455
Mailing Address - Country:US
Mailing Address - Phone:425-351-1059
Mailing Address - Fax:
Practice Address - Street 1:6957 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1953
Practice Address - Country:US
Practice Address - Phone:425-390-4303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60620333251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health