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General NPI Number Information
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NPI Number | 1669738621
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Entity Type | Organization
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Legal Business Name | THE RIGHT CHOICE BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 4405 MALL BLVD SUITE 310
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City | UNION CITY
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State | GA
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Zip | 30291-2044
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Country | US
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Telephone | 770-365-3140
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 862
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City | FAIRBURN
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State | GA
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Zip | 30213-0862
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | GRACE BLACKWOOD
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Credential |
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Telephone | 770-365-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC00495
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License Number State | GA
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