=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164934337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADDICTION RECOVERY COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2017
-----------------------------------------------------
Last Update Date | 10/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 NASA PKWY STE 220H
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77058-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-960-9194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2911 PRAIRIE HILL CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77059-3570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-433-7633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | PAUL DIGGINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-433-7633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 13313
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------