Healthcare Provider Details

I. General information

NPI: 1407620651
Provider Name (Legal Business Name): ROAD TO RECOVERY NEUROPSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 S NORCROSS TUCKER RD STE 6
NORCROSS GA
30093-5536
US

IV. Provider business mailing address

6131 S NORCROSS TUCKER RD STE 6
NORCROSS GA
30093-5536
US

V. Phone/Fax

Practice location:
  • Phone: 833-647-7924
  • Fax:
Mailing address:
  • Phone: 833-647-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS VINCENT MOORE JR.
Title or Position: OWNER
Credential:
Phone: 404-884-3321