Healthcare Provider Details

I. General information

NPI: 1326307257
Provider Name (Legal Business Name): A AFFORDABLE DUI SCHOOL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 05/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 HIGHWAY 85
RIVERDALE GA
30274-1609
US

IV. Provider business mailing address

6360 HIGHWAY 85
RIVERDALE GA
30274-1609
US

V. Phone/Fax

Practice location:
  • Phone: 770-996-9026
  • Fax: 770-996-5750
Mailing address:
  • Phone: 770-996-9026
  • Fax: 770-996-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number489
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number704020
License Number StateGA

VIII. Authorized Official

Name: MRS. LORRAINE OLIVER
Title or Position: DIRECTOR
Credential: M.ED, CADCII, ICADC
Phone: 770-996-9026