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Organization
MCINTOSH TRAIL CSB
Active
Organization
MCINTOSH TRAIL CSB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA P. ROBINSON LCSW, MAC, CCS (ADDICTIVE DISEASE COORDINATOR)
(770) 358-8470
Entity
Organization
Contact information
Practice address
136 N HILL ST, GRIFFIN, GA 30223-3335
(770) 358-8470
Mailing address
1436 CATHERINE ST, DECATUR, GA 30030-4505
(404) 377-0541
(404) 687-8853
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
000427
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000427
LIC.CLINICALSOCIALWORKER
GA
01
—
1000
CERTIFIEDADDICTIONCOUN II
GA
Enumeration date
04/17/2007
Last updated
07/07/2008
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