Organization
ANTIDOTE RECOVERY LLC
Active
Organization
ANTIDOTE RECOVERY LLC
Active
Other names
R. Miguel Magallanez LCSW, Antidote Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTO MIGUEL MAGALLANEZ LCSW (CEO)
(812) 624-1180
Entity
Organization
Contact information
Practice address
3310 E 10TH ST # 4-156, JEFFERSONVILLE, IN 47130-7285
(812) 624-1180
Mailing address
3310 E 10TH ST # 4-156, JEFFERSONVILLE, IN 47130-7285
(812) 624-1180
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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