Organization
GRN CSB
Active
Organization
GRN CSB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK E UNDERWOOD JR. LAPC (CLINICIAN)
(770) 339-2259
Entity
Organization
Contact information
Practice address
490 S PERRY ST, LAWRENCEVILLE, GA 30046-4837
(770) 339-2321
Mailing address
490 S PERRY ST, LAWRENCEVILLE, GA 30046-4837
(770) 339-2321
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
APC002422
GA
Other
Enumeration date
04/20/2011
Last updated
04/20/2011
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