Provider Demographics
NPI:1023314036
Name:ADDICTION AND BEHAVIORAL COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:ADDICTION AND BEHAVIORAL COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTROR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ISAILOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC II/AODA
Authorized Official - Phone:219-756-3791
Mailing Address - Street 1:7805 TAFT ST.
Mailing Address - Street 2:SUITE E
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5237
Mailing Address - Country:US
Mailing Address - Phone:219-756-3791
Mailing Address - Fax:219-756-3793
Practice Address - Street 1:7805 TAFT ST
Practice Address - Street 2:SUITE E
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5233
Practice Address - Country:US
Practice Address - Phone:219-756-3791
Practice Address - Fax:219-756-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1198-0-ASO251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health