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General NPI Number Information
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NPI Number | 1699664060
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Entity Type | Organization
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Legal Business Name | THREE RIVERS RECOVERY AND WELLNESS LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 84 E OAKLAND AVE
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City | CAMILLA
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State | GA
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Zip | 31730-1529
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Country | US
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Telephone | 229-336-9769
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Fax |
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Provider Business Mailing Address
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Address Line | 84 E OAKLAND AVE
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City | CAMILLA
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State | GA
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Zip | 31730-1529
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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 | PRESIDENT
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Name | ANTONIO MILLER
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Credential |
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Telephone | 229-449-6671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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