Provider Demographics
NPI:1902198245
Name:ALTERNATIVE ENRICHMENT CENTER
Entity Type:Organization
Organization Name:ALTERNATIVE ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-410-5184
Mailing Address - Street 1:5709 ENOREE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5773
Mailing Address - Country:US
Mailing Address - Phone:954-410-5184
Mailing Address - Fax:919-400-4210
Practice Address - Street 1:5102 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3394
Practice Address - Country:US
Practice Address - Phone:919-584-5443
Practice Address - Fax:919-400-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty