| Doctor Name: | ALAN A ABRAHAM |
| NPI Number: | 1013018480 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ALCOHOL DRUG COUNSEL |
| License Number: | 301462 |
| Business Practice Address: | 626 S 13th St Detox Range Treatment Center Virginia, MN - 55792 |
| Business Phone Number: | 2187419120 |
| Business Fax Number: | 2187413170 |
| Mailing Address: | 626 S 13th St, Detox Range Treatment Center VIRGINIA |
| State: | MN |
| Postal Code: | 55792 |
| Phone Number: | 2187419120 |
| Fax Number: | 2187413170 |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 301462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |