Provider Demographics
NPI:1104120468
Name:ALTERNATIVE THERAPY LLC
Entity type:Organization
Organization Name:ALTERNATIVE THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MPA,CAGS, NCC, LPC
Authorized Official - Phone:203-281-0300
Mailing Address - Street 1:2911 DIXWELL AVE STE 301
Mailing Address - Street 2:SUITE 9
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3130
Mailing Address - Country:US
Mailing Address - Phone:203-281-0300
Mailing Address - Fax:
Practice Address - Street 1:2911 DIXWELL AVE STE 301
Practice Address - Street 2:SUITE 9
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3130
Practice Address - Country:US
Practice Address - Phone:203-281-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty