| Organization Name: | ROOSEVELT'S CHARACTER DEVELOPMENT CENTER |
| NPI Number: | 1083070718 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROOSEVELT CONE (OWNER) |
| Mailing Address: | 119 S College St Statesboro |
| State: | GA US |
| Postal Code: | 304585202 |
| Phone Number: | 9125412809 |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2016 |
| NPI Last Update Date: | 01/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |