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General NPI Number Information
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NPI Number | 1245533546
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CHEMICAL AWARENESS PROGRAMS (C-CAP)
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 9560 SKILLMAN ST STE 118
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City | DALLAS
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State | TX
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Zip | 75243-8256
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Country | US
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Telephone | 214-221-5900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541626
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City | DALLAS
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State | TX
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Zip | 75354-1626
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Country | US
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Telephone | 214-221-5900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUSTIN EZEOHA
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Credential |
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Telephone | 214-221-5900
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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 | 11293-1209
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19813
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13423
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6998
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License Number State | TX
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