| Organization Name: | LUZERNE/WYOMING COUNTIES DRUG AND ALCOHOL PROGRAM |
| NPI Number: | 1215027602 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL DONAHUE (D&A PROGRAM ADMINISTRATOR) |
| Mailing Address: | 20 N Pennsylvania Ave Penn Place Building Suite 218 Wilkes-barre |
| State: | PA US |
| Postal Code: | 187013509 |
| Phone Number: | 5708268790 |
| Fax Number: | 5708263079 |
| NPI Enumeration Date: | 10/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |