Provider Demographics
NPI:1134140809
Name:CHILD AND FAMILY GUIDANCE CENTER ADDICTION SERVICE INC
Entity Type:Organization
Organization Name:CHILD AND FAMILY GUIDANCE CENTER ADDICTION SERVICE INC
Other - Org Name:STEP ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:845-691-9191
Mailing Address - Street 1:106 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1422
Mailing Address - Country:US
Mailing Address - Phone:845-691-9191
Mailing Address - Fax:845-691-6993
Practice Address - Street 1:106 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1422
Practice Address - Country:US
Practice Address - Phone:845-691-9191
Practice Address - Fax:845-691-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty