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General NPI Number Information
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NPI Number | 1750717682
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Entity Type | Organization
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Legal Business Name | PROJECT ADAM COMMUNITY ASSISTANCE CENTER, INCORPORATED
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 112 LANTHIER ST
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City | WINDER
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State | GA
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Zip | 30680-8100
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Country | US
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Telephone | 770-867-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 112 LANTHIER ST P.O. BOX 2
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City | WINDER
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State | GA
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Zip | 30680-8100
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Country | US
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Telephone | 770-867-8003
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LORI GINA MCDONALD
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Credential | NCAC, II
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Telephone | 770-867-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | DRUG001016
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License Number State | GA
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