Healthcare Provider Details

I. General information

NPI: 1942036579
Provider Name (Legal Business Name): FIRST STEP RECOVERY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 SOUTHLAKE PKWY STE 102
JONESBORO GA
30236-2495
US

IV. Provider business mailing address

7544 SOUTHLAKE PKWY STE 102
JONESBORO GA
30236-2495
US

V. Phone/Fax

Practice location:
  • Phone: 404-884-1461
  • Fax:
Mailing address:
  • Phone: 404-884-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. BRITTANY ROBINSON
Title or Position: CEO
Credential:
Phone: 404-931-6105