Provider Demographics
NPI:1316537996
Name:ADDICTION AND SUBSTANCE ABUSE PROFESSIONALS CLINIC
Entity type:Organization
Organization Name:ADDICTION AND SUBSTANCE ABUSE PROFESSIONALS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:MICHAELLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-437-0097
Mailing Address - Street 1:419 TOWN MOUNTAIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1632
Mailing Address - Country:US
Mailing Address - Phone:660-437-0097
Mailing Address - Fax:606-328-5440
Practice Address - Street 1:419 TOWN MOUNTAIN RD STE 103
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1632
Practice Address - Country:US
Practice Address - Phone:660-437-0097
Practice Address - Fax:606-328-5440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALCOHOL AND SUBSTANCE ABUSE PROFESSIONALS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-19
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty