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General NPI Number Information
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NPI Number | 1588198014
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Entity Type | Organization
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Legal Business Name | WAYPOINT RANCH CLC, INC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 195 LITTLE RIVER RD
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City | CARROLLTON
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State | GA
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Zip | 30117-7695
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Country | US
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Telephone | 678-459-7825
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Fax |
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Provider Business Mailing Address
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Address Line | 195 LITTLE RIVER RD
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City | CARROLLTON
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State | GA
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Zip | 30117-7695
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Country | US
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Telephone | 678-459-7825
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAY S CIRASA
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Credential |
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Telephone | 678-459-7825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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