Basic Information
| Provider Information | |||||||||
| NPI: | 1093336372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLVIN | ||||||||
| FirstName: | GINGER | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CDPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 N ASH ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992012803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093273120 | ||||||||
| FaxNumber: | 5093273228 | ||||||||
| Practice Location | |||||||||
| Address1: | 218 N OAK ST STE B | ||||||||
| Address2: | |||||||||
| City: | COLVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991142968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096845867 | ||||||||
| FaxNumber: | 5096841925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2020 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.