MEDICARE: NEVER GIVE UP RECOVERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C0126	GA

General Provider Information

NPI Number	:	1699019034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVER GIVE UP RECOVERY, LLC

Provider Business Mailing Address
First Line	:	2514 HIGHLAND PARC PL SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-2425
Country	:	US
Telephone Number	:	404-453-5620
Fax Number	:

Provider Business Practice Location Address
First Line	:	2514 HIGHLAND PARC PL SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-2425
Country	:	US
Telephone Number	:	404-453-5620
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	COLLEEN J GRAY
Credential	:	MA, CCAADC, ICAADC
Telephone Number	:	404-453-5620

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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