Provider Demographics
NPI:1336463488
Name:SLV FAMILY & ADDICTIONS COUNSELING, CORP
Entity Type:Organization
Organization Name:SLV FAMILY & ADDICTIONS COUNSELING, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAC III
Authorized Official - Phone:719-589-2974
Mailing Address - Street 1:10 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2045
Mailing Address - Country:US
Mailing Address - Phone:719-589-2974
Mailing Address - Fax:719-589-2974
Practice Address - Street 1:716 MAIN ST
Practice Address - Street 2:#205
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2540
Practice Address - Country:US
Practice Address - Phone:719-589-2974
Practice Address - Fax:719-589-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAA86261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)