Healthcare Provider Details

I. General information

NPI: 1427333970
Provider Name (Legal Business Name): ALTERNATIVE CHOICE COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 E MAIN ST
HUMBOLDT TN
38343-3327
US

IV. Provider business mailing address

1309 E MAIN ST
HUMBOLDT TN
38343-3327
US

V. Phone/Fax

Practice location:
  • Phone: 731-784-8814
  • Fax: 731-784-9920
Mailing address:
  • Phone: 731-784-8814
  • Fax: 731-784-9920

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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI A TUBBS-DOUGLAS
Title or Position: DIRECTOR
Credential: BS/LADAC2/NCAC2/QCS
Phone: 731-784-8814