NPI 1619403219

Mister Life Coach

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Decatur, GA

Practice location

Address: 3681 N Decatur Rd APT R11, Decatur, GA 30032-1062
Phone: (631) 553-7131
Mailing address: PO Box 283, Rex, GA 30273-0283

Authorised official

Name: Robert Green
Title: Life Coach
Phone: (631) 553-7131

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

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Registry record

NPI: 1619403219
Entity type: Organization
NPI issued: 3 May 2017
Record last updated: 3 May 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.