Healthcare Provider Details

I. General information

NPI: 1700336419
Provider Name (Legal Business Name): ACHIEVEMENT ASSOCIATES GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 W FOND DU LAC AVE
MILWAUKEE WI
53216-1346
US

IV. Provider business mailing address

PO BOX 418
MONROE NY
10949-0418
US

V. Phone/Fax

Practice location:
  • Phone: 414-871-9111
  • Fax:
Mailing address:
  • Phone: 414-871-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ABE FREUND
Title or Position: MEMBER
Credential:
Phone: 414-871-9111