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General NPI Number Information
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NPI Number | 1750728457
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Entity Type | Organization
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Legal Business Name | TYRONE HURST CAC
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 2020 DEWBERRY LN
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City | EAST POINT
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State | GA
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Zip | 30344-1136
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Country | US
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Telephone | 404-993-2601
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Fax | 855-420-5792
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Provider Business Mailing Address
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Address Line | 2020 DEWBERRY LN
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City | EAST POINT
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State | GA
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Zip | 30344
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Country | US
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Telephone | 404-993-2601
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Fax | 855-420-5792
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Authorized Official
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Title or Position | CERTIFIED ADDICTION COUNSELOR
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Name | MR. TYRONE L HURST
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Credential | CAC
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Telephone | 404-993-2601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1952
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License Number State | GA
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