Provider Demographics
NPI:1215027602
Name:LUZERNE/WYOMING COUNTIES DRUG AND ALCOHOL PROGRAM
Entity Type:Organization
Organization Name:LUZERNE/WYOMING COUNTIES DRUG AND ALCOHOL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D&A PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:570-826-8790
Mailing Address - Street 1:20 N PENNSYLVANIA AVE
Mailing Address - Street 2:PENN PLACE BUILDING SUITE 218
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-3509
Mailing Address - Country:US
Mailing Address - Phone:570-826-8790
Mailing Address - Fax:570-826-3079
Practice Address - Street 1:20 N PENNSYLVANIA AVE
Practice Address - Street 2:PENN PLACE BUILDING SUITE 218
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-3509
Practice Address - Country:US
Practice Address - Phone:570-826-8790
Practice Address - Fax:570-826-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty