Provider Demographics
NPI:1558554675
Name:ALASE CENTER FOR ENRICHMENT II
Entity Type:Organization
Organization Name:ALASE CENTER FOR ENRICHMENT II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TOWANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-957-7357
Mailing Address - Street 1:6015 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-957-7357
Mailing Address - Fax:919-957-9539
Practice Address - Street 1:6015 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-957-7357
Practice Address - Fax:919-957-9539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALASE CENTER FOR ENRICHMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X
NC2606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005138Medicaid