Willow Creek Adolescent Substance Abuse Program
Counselor, Addiction (Substance Use Disorder) in Ellijay, GA. Organization (NPI-2).
NPI number1114174331
StatusActive
Last updated in NPPESAug 19, 2008
Details
- NPI
- 1114174331
- Entity type
- Organization (NPI-2)
- Legal business name
- Willow Creek Adolescent Substance Abuse Program
- Organization subpart
- No
- Enumeration date
- Aug 19, 2008
- Last updated
- Aug 19, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | LPC003706 | GA | Yes |
Practice location
10 Kiker StEllijay, GA 30540-3700
Phone 706-636-2692 · Fax 706-636-2694
Mailing address
10 Kiker StEllijay, GA 30540-3700
Phone 706-636-2692 · Fax 706-636-2694
Authorized official
Larry W Hooks
Ceo And Director
7066362692
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