Organization Name: | LIFE INTERVENTION NETWORK CENTER |
NPI Number: | 1588059232 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELVIN BROWN (MENTAL HEALTH/SUBSTANCE ABUSE COUNS) |
Mailing Address: | 2551 River Forest Ct Ellenwood |
State: | GA US |
Postal Code: | 302941270 |
Phone Number: | 8502645745 |
Fax Number: | |
NPI Enumeration Date: | 03/31/2015 |
NPI Last Update Date: | 03/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |