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General NPI Number Information
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NPI Number | 1003364910
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Entity Type | Organization
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Legal Business Name | AGAPE SUBSTANCE ABUSE PROGRAM
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 9001 AIRPORT BLVD SUITE 707
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City | HOUSTON
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State | TX
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Zip | 77061-3474
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Country | US
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Telephone | 713-783-5437
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2175
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City | PEARLAND
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State | TX
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Zip | 77588-2175
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Country | US
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Telephone | 713-783-5437
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HELEN MIGNON DAVIS
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Credential | B.S., LCDC
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Telephone | 713-783-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10003
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License Number State | TX
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