Healthcare Provider Details

I. General information

NPI: 1619947348
Provider Name (Legal Business Name): CARBON - MONROE - PIKE DRUG & ALCOHOL COMMISSION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S. 7TH ST
LEHIGHTON PA
18235-1824
US

IV. Provider business mailing address

724 PHILLIPS STREET SUITE 203
STROUDSBURG PA
18360-2242
US

V. Phone/Fax

Practice location:
  • Phone: 610-377-5177
  • Fax: 610-377-5099
Mailing address:
  • Phone: 570-421-1960
  • Fax: 570-421-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number131044
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number451044
License Number StatePA

VIII. Authorized Official

Name: MRS. JAMIE LYNN DRAKE
Title or Position: EXECUTIVE DIRECTOR
Credential: BS CADC
Phone: 570-421-1960