# 30:17 RECOVERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679331284
- **Authorized official:** MELISSA MCBROOM (DIRECTOR)
- **Authorized official phone:** (731) 215-0449

## Contact information

- **Practice address:** 188 CARRIAGE HOUSE DR, JACKSON, TN 38305-3969
- **Practice address phone:** (731) 215-0049
- **Practice address fax:** (800) 418-1395
- **Mailing address:** 188 CARRIAGE HOUSE DR, JACKSON, TN 38305-3969
- **Mailing address phone:** (731) 215-0049
- **Mailing address fax:** (800) 418-1395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/08/2024
- **Last updated:** 03/08/2024