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General NPI Number Information
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NPI Number | 1730756719
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Entity Type | Organization
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Legal Business Name | THE EXTENSION INC
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 1507 CHURCH STREET EXT NE
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City | MARIETTA
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State | GA
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Zip | 30060-1023
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Country | US
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Telephone | 770-590-9075
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 CHURCH STREET EXT NE
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City | MARIETTA
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State | GA
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Zip | 30060-1023
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Country | US
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Telephone | 770-590-9075
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | STEPHANIE GLOVER
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Credential |
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Telephone | 770-590-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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