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General NPI Number Information
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NPI Number | 1336721117
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Entity Type | Organization
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Legal Business Name | ALCOHOL & DRUG DEPENDENCY SERVICES OF SE IOWA
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 1340 MT. PLEASANT ST
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City | BURLINGTON
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State | IA
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Zip | 52601
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Country | US
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Telephone | 317-753-6567
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Fax | 319-753-0703
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Provider Business Mailing Address
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Address Line | 1340 MT. PLEASANT ST
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City | BURLINGTON
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State | IA
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Zip | 52601
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Country | US
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Telephone | 317-753-6567
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Fax | 319-753-0703
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Authorized Official
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Title or Position | ASSOC. DIRECTOR OF ADMIN
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Name | LENA JONES
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Credential |
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Telephone | 319-753-6567
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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