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General NPI Number Information
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NPI Number | 1356671531
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Entity Type | Organization
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Legal Business Name | HOUSE OF PREPARATION, LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 110 EAGLE SPRING DR SUITE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6488
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Country | US
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Telephone | 866-945-9685
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Fax | 866-945-9685
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Provider Business Mailing Address
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Address Line | PO BOX 321
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City | MCDONOUGH
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State | GA
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Zip | 30253-0321
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Country | US
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Telephone | 866-945-9685
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Fax | 866-945-9685
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. CASANDRA JONES
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Credential | MS, NCC
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Telephone | 866-945-9685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 441931037035
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License Number State | GA
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