| Organization Name: | WILLOW CREEK ADOLESCENT SUBSTANCE ABUSE PROGRAM |
| NPI Number: | 1114174331 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARRY W HOOKS (CEO AND DIRECTOR) |
| Mailing Address: | 10 Kiker St Ellijay |
| State: | GA US |
| Postal Code: | 305403700 |
| Phone Number: | 7066362692 |
| Fax Number: | 7066362694 |
| NPI Enumeration Date: | 08/19/2008 |
| NPI Last Update Date: | 08/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LPC003706 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |