Basic Information
| Provider Information | |||||||||
| NPI: | 1063064715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRUG ABUSE ALTERNATIVES CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2403 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954033007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2403 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954033007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075443295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAGUIRE | ||||||||
| AuthorizedOfficialFirstName: | MELODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OUTPATIENT SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7075443295 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTER POINT | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.