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General NPI Number Information
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NPI Number | 1104285410
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Entity Type | Organization
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Legal Business Name | THE ROAD TO RECOVERY
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 3155 PRESIDENTIAL DR SUITE 104
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City | ATLANTA
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State | GA
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Zip | 30340-3924
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Country | US
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Telephone | 770-220-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 3155 PRESIDENTIAL DR SUITE 104
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City | ATLANTA
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State | GA
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Zip | 30340-3924
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Country | US
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Telephone | 770-220-2885
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOTHERAPIST
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Name | MS. ROCIO WOODY
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Credential | LCSW
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Telephone | 770-220-2885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004800
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CSW004800
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | CSW004800
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CSW004800
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License Number State | GA
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