Provider Demographics
NPI:1427333970
Name:ALTERNATIVE CHOICE COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:ALTERNATIVE CHOICE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUBBS-DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:BS/LADAC2/NCAC2/QCS
Authorized Official - Phone:731-784-8814
Mailing Address - Street 1:1309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3327
Mailing Address - Country:US
Mailing Address - Phone:731-784-8814
Mailing Address - Fax:731-784-9920
Practice Address - Street 1:1309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3327
Practice Address - Country:US
Practice Address - Phone:731-784-8814
Practice Address - Fax:731-784-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017854Medicaid