Healthcare Provider Details

I. General information

NPI: 1225568470
Provider Name (Legal Business Name): LARRY ALWINE MA, LPC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PLAINVILLE RD NE
ROME GA
30161-3990
US

IV. Provider business mailing address

610 PLAINVILLE RD NE
ROME GA
30161-3990
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-3510
  • Fax: 719-938-1914
Mailing address:
  • Phone: 719-415-3510
  • Fax: 719-938-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0000920
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0014390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: