Provider Demographics
NPI:1730614595
Name:DEPARTMENT OF VETERAN AFFAIRS
Entity type:Organization
Organization Name:DEPARTMENT OF VETERAN AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEER SUPPORT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:COUCHOIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPSS
Authorized Official - Phone:205-306-1119
Mailing Address - Street 1:500 MARKAVIEW RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-3652
Mailing Address - Country:US
Mailing Address - Phone:256-533-8477
Mailing Address - Fax:256-534-0964
Practice Address - Street 1:500 MARKAVIEW RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-3652
Practice Address - Country:US
Practice Address - Phone:256-533-8477
Practice Address - Fax:256-534-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADBSA101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty