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General NPI Number Information
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NPI Number | 1528368081
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Entity Type | Organization
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Legal Business Name | ADDICTION SERVICES CS, LLC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 1103 UNIVERSITY DR E SUITE 100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2357
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Country | US
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Telephone | 979-599-9450
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Fax | 979-599-9451
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Provider Business Mailing Address
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Address Line | 1103 UNIVERSITY DR E SUITE 100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2357
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Country | US
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Telephone | 979-599-9450
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Fax | 979-599-9451
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Authorized Official
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Title or Position | CEO
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Name | MR. PHILLIP D YOUNG
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Credential |
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Telephone | 979-599-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 1000020
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License Number State | TX
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