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General NPI Number Information
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NPI Number | 1144037540
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Entity Type | Organization
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Legal Business Name | FAITH RECOVERY TREATMENT CENTER
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1201 W PEACHTREE ST NW STE 2300
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City | ATLANTA
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State | GA
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Zip | 30309-3453
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Country | US
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Telephone | 571-330-1430
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 W PEACHTREE ST NW STE 2300
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City | ATLANTA
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State | GA
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Zip | 30309-3453
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Country | US
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Telephone | 571-330-1430
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | SHANEKIA DYSHA SELBY
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Credential |
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Telephone | 571-330-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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