Provider Demographics
NPI:1285775155
Name:NORTHUMBERLAND COUNTY DRUG & ALCOHOL PROGRAM
Entity type:Organization
Organization Name:NORTHUMBERLAND COUNTY DRUG & ALCOHOL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG & ALCOHOL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, CAC
Authorized Official - Phone:570-495-2161
Mailing Address - Street 1:217 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2205
Mailing Address - Country:US
Mailing Address - Phone:570-495-2154
Mailing Address - Fax:570-988-4347
Practice Address - Street 1:217 N CENTER ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2205
Practice Address - Country:US
Practice Address - Phone:570-495-2154
Practice Address - Fax:570-988-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA497022251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA497022OtherFACILITY LICENSE NUMBER