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General NPI Number Information
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NPI Number | 1558532671
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Entity Type | Organization
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Legal Business Name | WYOMING VALLEY ALCOHOL & DRUG SERVICES, INC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 49 SOUTH MAIN ST.
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City | PITTSTON
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State | PA
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Zip | 18640
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Country | US
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Telephone | 570-820-8888
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Fax | 570-820-8899
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Provider Business Mailing Address
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Address Line | 437 NORTH MAIN ST.
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City | WILKES BARRE
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State | PA
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Zip | 18705
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Country | US
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Telephone | 570-820-8888
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Fax | 570-820-8899
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Authorized Official
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Title or Position | CEO
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Name | JASON HARLEN
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Credential | M.A.
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Telephone | 570-820-8888
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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 | 401216
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License Number State | PA
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