Basic Information
| Provider Information | |||||||||
| NPI: | 1023314036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADDICTION AND BEHAVIORAL COUNSELING SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7805 TAFT ST. | ||||||||
| Address2: | SUITE E | ||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464105237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197563791 | ||||||||
| FaxNumber: | 2197563793 | ||||||||
| Practice Location | |||||||||
| Address1: | 7805 TAFT ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464105233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197563791 | ||||||||
| FaxNumber: | 2197563793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2011 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | ISAILOVICH | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTROR | ||||||||
| AuthorizedOfficialTelephone: | 2197563791 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CADAC II/AODA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 1198-0-ASO | IN | Y | Agencies | Community/Behavioral Health |
No ID Information.