Provider Demographics
NPI:1164778460
Name:COUNCIL ON ALCOHOLISM & DRUG ABUSE OF SULLIVAN COUNTY
Entity Type:Organization
Organization Name:COUNCIL ON ALCOHOLISM & DRUG ABUSE OF SULLIVAN COUNTY
Other - Org Name:RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:IZETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS-BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CASAC-G
Authorized Official - Phone:845-794-8080
Mailing Address - Street 1:11 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1319
Mailing Address - Country:US
Mailing Address - Phone:845-794-8080
Mailing Address - Fax:845-791-1716
Practice Address - Street 1:11 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1319
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:845-791-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1437238706324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility