Provider Demographics
NPI:1235551094
Name:ABI-ALTERNATIVE INTERVENTION DBA ABI BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ABI-ALTERNATIVE INTERVENTION DBA ABI BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:BIANCA
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC-S, JD
Authorized Official - Phone:502-425-7325
Mailing Address - Street 1:104 DAVENTRY LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3845
Mailing Address - Country:US
Mailing Address - Phone:502-425-7325
Mailing Address - Fax:
Practice Address - Street 1:104 DAVENTRY LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3845
Practice Address - Country:US
Practice Address - Phone:502-425-7325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100294190Medicaid