Provider Demographics
NPI:1699125435
Name:NEW LIFE ADDICTION AND RECOVERY SERVICES PLLC
Entity type:Organization
Organization Name:NEW LIFE ADDICTION AND RECOVERY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MELANIE
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHCA, CDPT
Authorized Official - Phone:206-407-3333
Mailing Address - Street 1:5019 GROVE ST # 103A
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4487
Mailing Address - Country:US
Mailing Address - Phone:206-407-3333
Mailing Address - Fax:
Practice Address - Street 1:5019 GROVE ST # 103A
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4487
Practice Address - Country:US
Practice Address - Phone:206-407-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60535562101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty