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General NPI Number Information
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NPI Number | 1649495268
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Entity Type | Organization
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Legal Business Name | MCINTOSH TRAIL CSB
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 136 N HILL ST
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City | GRIFFIN
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State | GA
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Zip | 30223-3335
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Country | US
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Telephone | 770-358-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 1436 CATHERINE ST
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City | DECATUR
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State | GA
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Zip | 30030-4505
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Country | US
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Telephone | 404-377-0541
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Fax | 404-687-8853
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Authorized Official
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Title or Position | ADDICTIVE DISEASE COORDINATOR
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Name | MS. LINDA P. ROBINSON
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Credential | LCSW, MAC, CCS
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Telephone | 770-358-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 000427
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License Number State | GA
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