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General NPI Number Information
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NPI Number | 1417959099
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Entity Type | Organization
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Legal Business Name | CHILD & FAMILY GUIDANCE CENTER CENTER ADDICTION SERVICES, INC.
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 VINEYARD AVE
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City | HIGHLAND
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State | NY
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Zip | 12528-1422
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Country | US
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Telephone | 845-691-9191
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Fax | 845-691-9339
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Provider Business Mailing Address
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Address Line | 102 VINEYARD AVE
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City | HIGHLAND
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State | NY
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Zip | 12528-1422
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Country | US
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Telephone | 845-691-9191
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Fax | 845-691-9339
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR / CEO
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Name | ROGER OWEN SPOOL
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Credential | LCSW-R, BCD
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Telephone | 845-691-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | NY
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