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General NPI Number Information
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NPI Number | 1871212480
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Entity Type | Organization
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Legal Business Name | HOUSE OF RED AND GREY GROUP
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 3863 HIGHWAY 138 SE UNIT 170
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4143
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Country | US
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Telephone | 770-284-1018
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Fax |
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Provider Business Mailing Address
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Address Line | 5346 ALTHEAS CT
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City | ELLENWOOD
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State | GA
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Zip | 30294-4334
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Country | US
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Telephone | 404-583-1330
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | ASHLEE SLEDGE
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Credential |
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Telephone | 404-583-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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