=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730456401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST ALTERNATIVES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2011
-----------------------------------------------------
Last Update Date | 11/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4309 UNITED ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-337-2963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4309 UNITED ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-337-2963
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DONALD W SWAYNE
-----------------------------------------------------
Credential | LCSW, LCAS
-----------------------------------------------------
Telephone | 336-337-2963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1357
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C004259
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------