Healthcare Provider Details

I. General information

NPI: 1194744227
Provider Name (Legal Business Name): ALCOHOL & DRUG COUNCIL OF TOMPKINS COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST STE 500
ITHACA NY
14850-5635
US

IV. Provider business mailing address

201 E GREEN ST STE 500
ITHACA NY
14850-5635
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6288
  • Fax: 607-274-6280
Mailing address:
  • Phone: 607-274-6288
  • Fax: 607-274-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number070410653
License Number StateNY

VIII. Authorized Official

Name: LYNNE TEETER
Title or Position: DIRECTOR OF FINANCE & ADMINISTRATIO
Credential:
Phone: 607-274-6288