Organization
MENTOR ONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAVETA SYLVONYA FUTCH PH.D., M.A., B.A. (DIRECTOR)
(404) 838-7903
Entity
Organization
Contact information
Practice address
4291 CAROLINE CT, DOUGLASVILLE, GA 30135-8227
(404) 838-7903
(678) 324-6869
Mailing address
PO BOX 1806, LITHIA SPRINGS, GA 30122-1172
(404) 838-7903
(678) 324-6869
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
GA00077528
GA
Other
Enumeration date
12/16/2011
Last updated
12/16/2011
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