Phil Waggoner
Phil Waggoner is an Addiction (Substance Use Disorder) Counselor in Lewiston, Idaho. Licensed in Idaho. Registered with an NPI since 2006.
- Licensed in
- ID
- In the registry since
- 2006
Practice location Address checks out
1720 18th AveLewiston, ID 83501-4047
Phone: (208) 746-4097
Fax: (208) 746-2294
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Specialties & licences
| Addiction (Substance Use Disorder) Counselor (primary) | Taxonomy 101YA0400X · Licence 138 (ID) |
|---|
Record details
| NPI number | 1871651422 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Dana Boyd — Business Ofc Manager Owner · (208) 746-4097 |
| Other names | Riverside Recovery |
| NPI enumerated | December 5, 2006 |
| Last updated in NPPES | August 22, 2020 |
| Mailing address | 1720 18th Ave, Lewiston, ID 83501 |
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Mr. Bobby Leon Pascoe Jr.
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Riverside Recovery LLC
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Mr. Anthony Brian Tenny, CADC
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