Provider Demographics
NPI:1649692344
Name:ALCOHOL AND SUBSTANCE ABUSE PROFESSIONALS
Entity type:Organization
Organization Name:ALCOHOL AND SUBSTANCE ABUSE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:606-437-0097
Mailing Address - Street 1:118 CAROLINE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3988
Mailing Address - Country:US
Mailing Address - Phone:606-437-0097
Mailing Address - Fax:606-657-0205
Practice Address - Street 1:118 CAROLINE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3988
Practice Address - Country:US
Practice Address - Phone:606-437-0097
Practice Address - Fax:606-657-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810148251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health