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General NPI Number Information
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NPI Number | 1154031672
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Entity Type | Organization
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Legal Business Name | SAMATRA SA COUNSELING, EDUCATION AND TRAININGS
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 1000 IRIS DR SW # 200D
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City | CONYERS
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State | GA
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Zip | 30094-6632
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Country | US
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Telephone | 404-838-1271
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Fax |
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Provider Business Mailing Address
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Address Line | 4868 OZMENT TRL
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City | STONECREST
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State | GA
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Zip | 30038-6208
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Country | US
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Telephone | 404-838-1271
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MS. SAMATRA L PHILLIPS
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Credential | MA, MAC, ICAADC
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Telephone | 404-838-1271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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