Provider Demographics
NPI:1407030463
Name:KEYSTONE RECOVERY, LLC
Entity Type:Organization
Organization Name:KEYSTONE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ASHLEY
Authorized Official - Middle Name:CASSITY
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ALC, MLA
Authorized Official - Phone:251-626-5797
Mailing Address - Street 1:29000 US HIGHWAY 98
Mailing Address - Street 2:SUITE A-203
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7272
Mailing Address - Country:US
Mailing Address - Phone:251-626-5797
Mailing Address - Fax:
Practice Address - Street 1:29000 US HIGHWAY 98
Practice Address - Street 2:SUITE A-203
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7272
Practice Address - Country:US
Practice Address - Phone:251-626-5797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL150MLAP101YA0400X
ALC1058A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty