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General NPI Number Information
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NPI Number | 1932479755
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Entity Type | Organization
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Legal Business Name | REBIRTH COUNSELING AND TRAINING CENTER
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Dates
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Enumeration Date | 01/10/2012
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 3120 S MARTIN ST STE 100
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City | EAST POINT
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State | GA
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Zip | 30344-4396
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Country | US
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Telephone | 678-705-5698
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Fax |
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Provider Business Mailing Address
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Address Line | 3120 S MARTIN ST STE 100
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City | EAST POINT
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State | GA
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Zip | 30344-4396
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Country | US
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Telephone | 404-867-3093
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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 | CAROLYN HARPE WALLER
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Credential | EDS.
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Telephone | 404-867-3093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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