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Organization
INTERVENTION SPECIALIST
Active
Organization
INTERVENTION SPECIALIST
Active
Parent organization
ENTERPRISE ALLIANCE GROUP DBA INTERVENTION SPECIALIST
Organization subpart
Yes
Provider details
NPI number
Legal business name
ENTERPRISE ALLIANCE GROUP DBA INTERVENTION SPECIALIST
Authorized official
MR. ROHAN CAMPBELL (CHIEF EXECUTIVE OFFICER)
(908) 289-0700
Entity
Organization
Contact information
Practice address
583 CHERRY ST, ELIZABETH, NJ 07208-1754
(973) 953-8896
(973) 953-8896
Mailing address
PO BOX 6063, WEST ORANGE, NJ 07052-9063
(973) 953-8896
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0501433
SAI
NJ
Enumeration date
12/12/2017
Last updated
12/12/2017
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