Healthcare Provider Details

I. General information

NPI: 1750156386
Provider Name (Legal Business Name): WARRIORS WELLNESS AND RECOVERY RANCH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 VALAMBROSIA RD
DUBLIN GA
31021-0900
US

IV. Provider business mailing address

585 VALAMBROSIA RD
DUBLIN GA
31021-0900
US

V. Phone/Fax

Practice location:
  • Phone: 478-304-7183
  • Fax: 877-298-8388
Mailing address:
  • Phone: 478-304-7183
  • Fax: 877-298-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAULA SMITH
Title or Position: CO-FOUNDER
Credential: DSW, LCSW, MSW
Phone: 203-889-7607