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General NPI Number Information
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NPI Number | 1578193835
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Entity Type | Organization
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Legal Business Name | STABILITY REBOOTED, LLC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 5833 STEWART PKWY STE 103
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-6933
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Country | US
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Telephone | 844-782-2454
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Fax | 833-782-2329
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Provider Business Mailing Address
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Address Line | 5833 STEWART PKWY STE 103
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-6933
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Country | US
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Telephone | 844-782-2454
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Fax | 833-782-2329
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Authorized Official
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Title or Position | CEO
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Name | MRS. REBEKAH REYNOLDS
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Credential | MSW, ICAADC, ARBS II
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Telephone | 470-532-1721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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