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General NPI Number Information
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NPI Number | 1659776300
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Entity Type | Organization
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Legal Business Name | HEALING HOUSE INC
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 3 HIGHLAND AVE
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City | BINGHAMTON
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State | NY
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Zip | 13905
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Country | US
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Telephone | 607-725-0440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2374
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City | BINGHAMTON
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State | NY
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Zip | 13902
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Country | US
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Telephone | 607-725-0440
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JOHN A DAVIDSON
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Credential | LCSW-R
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Telephone | 607-245-6259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RO70759-1
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License Number State | NY
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