Healthcare Provider Details

I. General information

NPI: 1740457811
Provider Name (Legal Business Name): ALCOHOL AND DRUG INFORMATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 CUNNINGHAM DR SUITE 336
HAMPTON VA
23666-3306
US

IV. Provider business mailing address

17577 BEALE PLACE DR
WINDSOR VA
23487-8345
US

V. Phone/Fax

Practice location:
  • Phone: 757-620-8536
  • Fax: 757-262-1544
Mailing address:
  • Phone: 757-620-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710101904
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA BILLS
Title or Position: DIRECTOR
Credential: CSAC
Phone: 757-620-8536