Organization
GRN: COMMUNITY SERVICE BOARDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ADELENE TRAYLOR (SSTSR)
(770) 784-0076
Entity
Organization
Contact information
Practice address
101 KIRKLAND RD, COVINGTON, GA 30016-3317
(770) 784-0076
(770) 784-3036
Mailing address
101 KIRKLAND RD, COVINGTON, GA 30016-3317
(770) 784-0076
(770) 784-3036
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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