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General NPI Number Information
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NPI Number | 1871008425
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Entity Type | Organization
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Legal Business Name | SURVIVAL 2 VICTORY, INC.
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 3579 CHAMBLEE TUCKER RD UNIT 941245A
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City | ATLANTA
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State | GA
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Zip | 31141-1009
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Country | US
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Telephone | 678-871-6543
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Fax |
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Provider Business Mailing Address
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Address Line | 3579A CHAMBLEE TUCKER RD # 941245
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City | ATLANTA
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State | GA
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Zip | 31141
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Country | US
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Telephone | 678-871-6543
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MRS. MERRY WARE
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Credential | LPC, NCC
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Telephone | 678-871-6543
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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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