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General NPI Number Information
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NPI Number | 1396868824
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Entity Type | Organization
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Legal Business Name | HEALTH REJUVENATIONS CONSULTANT, INC.
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 194 JONESBORO RD SUITE A-6
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City | JONESBORO
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State | GA
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Zip | 30236-4812
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Country | US
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Telephone | 404-731-6107
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Fax | 404-366-9947
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Provider Business Mailing Address
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Address Line | 4588 BOULDERCREST RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-3613
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Country | US
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Telephone | 404-731-6107
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Fax | 404-366-9947
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Authorized Official
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Title or Position | CEO-PSYCHOLOGIST
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Name | DR. DORIS D'NIN PATILLO
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Credential | PSYD. L.P.C., CACII
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Telephone | 404-731-6107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1594
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 004196
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License Number State | GA
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