Provider Demographics
NPI:1326473752
Name:INNOVATIVE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLET
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-241-8391
Mailing Address - Street 1:1826 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1516
Mailing Address - Country:US
Mailing Address - Phone:334-241-8391
Mailing Address - Fax:334-241-7094
Practice Address - Street 1:1826 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1516
Practice Address - Country:US
Practice Address - Phone:334-241-8391
Practice Address - Fax:334-241-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2961251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health