Provider Demographics
NPI:1962664581
Name:NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE,INC.
Entity type:Organization
Organization Name:NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-922-9217
Mailing Address - Street 1:2143 HURLEY WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3253
Mailing Address - Country:US
Mailing Address - Phone:916-924-4818
Mailing Address - Fax:916-921-1787
Practice Address - Street 1:2143 HURLEY WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3253
Practice Address - Country:US
Practice Address - Phone:916-924-4818
Practice Address - Fax:916-921-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA34AMOtherMEDI-CAL