Provider Demographics
NPI:1508202458
Name:DRUG PREVENTION RESOURCE CENTER D.B.A. INNERACT ALLIANCE
Entity Type:Organization
Organization Name:DRUG PREVENTION RESOURCE CENTER D.B.A. INNERACT ALLIANCE
Other - Org Name:INNERACT ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-802-0777
Mailing Address - Street 1:621 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5230
Mailing Address - Country:US
Mailing Address - Phone:863-802-0777
Mailing Address - Fax:863-802-0065
Practice Address - Street 1:621 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5230
Practice Address - Country:US
Practice Address - Phone:863-802-0777
Practice Address - Fax:863-802-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health