Provider Demographics
NPI:1730213257
Name:ALTERNATIVES CENTER FOR MENTAL WELLNESS INC
Entity type:Organization
Organization Name:ALTERNATIVES CENTER FOR MENTAL WELLNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JA'NITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBURY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PCC-S
Authorized Official - Phone:216-371-3420
Mailing Address - Street 1:14055 CEDAR RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3337
Mailing Address - Country:US
Mailing Address - Phone:216-371-3420
Mailing Address - Fax:
Practice Address - Street 1:14055 CEDAR RD
Practice Address - Street 2:SUITE 107
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3337
Practice Address - Country:US
Practice Address - Phone:216-371-3420
Practice Address - Fax:216-371-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2585582Medicaid
274742692026OtherCARESOURCE