Provider Demographics
NPI:1003364910
Name:AGAPE SUBSTANCE ABUSE PROGRAM
Entity Type:Organization
Organization Name:AGAPE SUBSTANCE ABUSE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:MIGNON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LCDC
Authorized Official - Phone:713-783-5437
Mailing Address - Street 1:PO BOX 2175
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-2175
Mailing Address - Country:US
Mailing Address - Phone:713-783-5437
Mailing Address - Fax:
Practice Address - Street 1:9001 AIRPORT BLVD
Practice Address - Street 2:SUITE 707
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-3474
Practice Address - Country:US
Practice Address - Phone:713-783-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10003101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13857527OtherCAQH
TX1841574654OtherNPI