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General NPI Number Information
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NPI Number | 1891217600
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Entity Type | Organization
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Legal Business Name | CROSSOVER OUTPATIENT SERVICES LLC
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 241 LEMON ST NE STE C
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City | MARIETTA
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State | GA
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Zip | 30060-1644
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Country | US
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Telephone | 404-400-1989
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Fax |
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Provider Business Mailing Address
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Address Line | 227 SANDY SPRINGS PL STE D-298
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5918
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Country | US
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Telephone | 404-400-1989
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN CRAIG BREMNER
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Credential | CACII, CCS
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Telephone | 770-639-7100
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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 |
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License Number State | GA
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