Healthcare Provider Details

I. General information

NPI: 1982203311
Provider Name (Legal Business Name): THE RECOVERY COACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 LAKE FORREST DR STE 450
ATLANTA GA
30328-3837
US

IV. Provider business mailing address

6100 LAKE FORREST DR STE 450
ATLANTA GA
30328-3837
US

V. Phone/Fax

Practice location:
  • Phone: 678-851-3314
  • Fax:
Mailing address:
  • Phone: 678-851-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALISON T BRODERICK
Title or Position: FOUNDER/OWNER
Credential: NCRC-II, CPS-AD
Phone: 678-851-3314