Healthcare Provider Details

I. General information

NPI: 1487869632
Provider Name (Legal Business Name): AUSTIN DRUG AND ALCOHOL ABUSE PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 N LAMAR BLVD SUITE D-109
AUSTIN TX
78752-1016
US

IV. Provider business mailing address

7801 N LAMAR BLVD SUITE D-109
AUSTIN TX
78752-1016
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-8180
  • Fax: 512-454-7441
Mailing address:
  • Phone: 512-454-8180
  • Fax: 512-454-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number654A
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number654-3266
License Number StateTX

VIII. Authorized Official

Name: MR. DAN GRANT DAVEY
Title or Position: EXECUTIVE DIRECTOR
Credential: LCDC, SAP
Phone: 512-454-8180