Provider Demographics
NPI:1295855690
Name:ALPHA COUNSELING & DWI SERVICES
Entity Type:Organization
Organization Name:ALPHA COUNSELING & DWI SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAS, LPC
Authorized Official - Phone:910-875-0070
Mailing Address - Street 1:132 W ELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2802
Mailing Address - Country:US
Mailing Address - Phone:910-875-0070
Mailing Address - Fax:910-875-0072
Practice Address - Street 1:132 W ELWOOD AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2802
Practice Address - Country:US
Practice Address - Phone:910-875-0070
Practice Address - Fax:910-875-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4122261QM0850X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health