Provider Demographics
NPI:1033783592
Name:ADDICTIONOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ADDICTIONOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORIE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:864-295-1280
Mailing Address - Street 1:206 WALL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6754
Mailing Address - Country:US
Mailing Address - Phone:864-295-1280
Mailing Address - Fax:
Practice Address - Street 1:206 WALL ST STE 2
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6754
Practice Address - Country:US
Practice Address - Phone:864-295-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTIONOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-18
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty