Healthcare Provider Details

I. General information

NPI: 1639670169
Provider Name (Legal Business Name): ALPHA 180 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 S LAMAR BLVD STE A
AUSTIN TX
78704-4709
US

IV. Provider business mailing address

2416 S LAMAR BLVD STE A
AUSTIN TX
78704-4709
US

V. Phone/Fax

Practice location:
  • Phone: 919-606-7392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLAAS DOORN
Title or Position: DIRECTOR OF RECOVERY SERVICES
Credential:
Phone: 919-606-7392