Provider Demographics
NPI:1558532671
Name:WYOMING VALLEY ALCOHOL & DRUG SERVICES, INC
Entity Type:Organization
Organization Name:WYOMING VALLEY ALCOHOL & DRUG SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:570-820-8888
Mailing Address - Street 1:437 NORTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705
Mailing Address - Country:US
Mailing Address - Phone:570-820-8888
Mailing Address - Fax:570-820-8899
Practice Address - Street 1:49 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:570-820-8888
Practice Address - Fax:570-820-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA401216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA401216OtherDEPARTMENT OF HEALTH