Provider Demographics
NPI:1194120261
Name:COUNCIL ON ALCOHOLSIM AND DRUG ABUSE
Entity type:Organization
Organization Name:COUNCIL ON ALCOHOLSIM AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MONITOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-320-0981
Mailing Address - Street 1:57 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1906
Mailing Address - Country:US
Mailing Address - Phone:402-320-0981
Mailing Address - Fax:
Practice Address - Street 1:57 SURREY PL
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1906
Practice Address - Country:US
Practice Address - Phone:402-320-0981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health