| NPI | 1306249990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYEAST REYNOLDS Director Of Rcm 678-813-0428 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: IL A-8526-001-A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2019-04-11 |