Provider Demographics
NPI:1740591296
Name:SOUTHEASTERN COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
Entity Type:Organization
Organization Name:SOUTHEASTERN COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:ICADC, CAC, CSS
Authorized Official - Phone:860-889-3178
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5840
Mailing Address - Country:US
Mailing Address - Phone:860-889-3178
Mailing Address - Fax:860-889-3414
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5840
Practice Address - Country:US
Practice Address - Phone:860-889-3178
Practice Address - Fax:860-889-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency