NPIMap

Organization Active NPI

Lincoln County Alcohol Drug Center

  • Addiction (Substance Use Disorder) Counselor
  • Davenport, WA
National Provider Identifier
1831381342
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CP00003123 Issued in WA
Legal business name
LINCOLN COUNTY ALCOHOL DRUG CENTER
Practice address
505 First St
Davenport, WA 99122-0152
Phone
(509) 725-2111
Fax
(509) 725-2141
NPI assigned
Aug 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Darren Mattozzi
Title
Director
Phone
(509) 725-2111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X CP00003123 WA Primary

Addresses

Primary practice location

505 First St
Davenport, WA 99122-0152

Mailing address

PO Box 152
Davenport, WA 99122-0152
Phone (509) 725-2111

Other identifiers 1

IdentifierTypeStateIssuer
1990340MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Lincoln County Counseling2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512691200000",
    "number": "1831381342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 152",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991220152",
            "telephone_number": "509-725-2111",
            "fax_number": "509-725-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 FIRST ST",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991220152",
            "telephone_number": "509-725-2111",
            "fax_number": "509-725-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY ALCOHOL DRUG CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2017-12-08",
        "status": "A",
        "authorized_official_last_name": "MATTOZZI",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "509-725-2111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00003123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1990340",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.