Healthcare Provider Details

I. General information

NPI: 1215399944
Provider Name (Legal Business Name): ALCHEMY INTERVENTION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 ROMIG RD
AKRON OH
44320-3879
US

IV. Provider business mailing address

2180 ROMIG RD
AKRON OH
44320-3879
US

V. Phone/Fax

Practice location:
  • Phone: 330-745-5488
  • Fax:
Mailing address:
  • Phone: 330-745-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: BERNARD DAMON TAYLOR
Title or Position: SUBSTANCE ABUSE THERAPIST
Credential: LICDC
Phone: 330-745-5488