Organization
INNOVATIVE CLINICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SEANLONDA N. COOLEY (CEO/OWNER)
(678) 826-6435
Entity
Organization
Contact information
Practice address
160 KYNDAL DR, HAMPTON, GA 30228-4862
(678) 826-6435
Mailing address
160 KYNDAL DR, HAMPTON, GA 30228-4862
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/07/2012
Last updated
02/07/2012
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