Provider Demographics
NPI:1902926835
Name:COUNCIL ON ALCOHOL AND DRUG ABUSE
Entity Type:Organization
Organization Name:COUNCIL ON ALCOHOL AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNICH
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, CAC
Authorized Official - Phone:610-437-0801
Mailing Address - Street 1:1031 W LINDEN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3988
Mailing Address - Country:US
Mailing Address - Phone:610-437-0801
Mailing Address - Fax:610-437-1997
Practice Address - Street 1:502 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1882
Practice Address - Country:US
Practice Address - Phone:610-814-3108
Practice Address - Fax:610-814-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA487029261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007531210001Medicaid