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Organization
MISTER LIFE COACH
Active
Organization
MISTER LIFE COACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT GREEN JR. (LIFE COACH)
(631) 553-7131
Entity
Organization
Contact information
Practice address
3681 N DECATUR RD APT R11, DECATUR, GA 30032-1062
(631) 553-7131
Mailing address
PO BOX 283, REX, GA 30273-0283
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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