Provider Demographics
NPI:1659771889
Name:HUMAN SERVICE ASSOCIATES
Entity Type:Organization
Organization Name:HUMAN SERVICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,THERAPIST,ADDICTION COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DETWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW,LCAS
Authorized Official - Phone:919-622-5776
Mailing Address - Street 1:833 WAKE FOREST BUSINESS PARK STE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7184
Mailing Address - Country:US
Mailing Address - Phone:919-622-5776
Mailing Address - Fax:480-393-5874
Practice Address - Street 1:833 WAKE FOREST BUSINESS PARK STE E
Practice Address - Street 2:SUITE E
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7184
Practice Address - Country:US
Practice Address - Phone:919-622-5776
Practice Address - Fax:480-393-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006918251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2853747Medicaid