Provider Demographics
NPI:1114381290
Name:INNOVATIVE SOBRIETY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE SOBRIETY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:Q-SUBSTANCE ABUSE PROFESSIONAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:AADC, MAC, CCBT
Authorized Official - Phone:334-399-3661
Mailing Address - Street 1:PO BOX 230441
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0441
Mailing Address - Country:US
Mailing Address - Phone:334-399-3661
Mailing Address - Fax:855-414-2958
Practice Address - Street 1:6707 TAYLOR CIR
Practice Address - Street 2:SUITE C
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7706
Practice Address - Country:US
Practice Address - Phone:334-399-3661
Practice Address - Fax:855-414-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management