Provider Demographics
NPI:1700229465
Name:DOUBLE A ADDICTION AND RECOVERY SERVICES LLC
Entity Type:Organization
Organization Name:DOUBLE A ADDICTION AND RECOVERY SERVICES LLC
Other - Org Name:TRANSITIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICDC-CS, LSW
Authorized Official - Phone:440-259-8253
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-7405
Mailing Address - Country:US
Mailing Address - Phone:440-259-8253
Mailing Address - Fax:440-259-8254
Practice Address - Street 1:4194 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9648
Practice Address - Country:US
Practice Address - Phone:440-259-8253
Practice Address - Fax:440-259-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OH14035251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty