Healthcare Provider Details

I. General information

NPI: 1396883583
Provider Name (Legal Business Name): COUNSELING ALTERNATIVES GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E COLLEGE AVE SUITE 460
STATE COLLEGE PA
16801-5558
US

IV. Provider business mailing address

444 E COLLEGE AVE SUITE 460
STATE COLLEGE PA
16801-5558
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-0940
  • Fax: 814-231-4702
Mailing address:
  • Phone: 814-231-0940
  • Fax: 814-231-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number147021
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOYCE MAURIN FONASH
Title or Position: MANAGING PARTNER
Credential: PHD
Phone: 814-231-0940