Organization
MCINTOSH TRAIL CSB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA P. ROBINSON LCSW, MAC, CCS (ADDICTIVE DISEASE COORDINATOR)
(770) 358-8470
Entity
Organization
Contact information
Practice address
136 N HILL ST, GRIFFIN, GA 30223-3335
(770) 358-8470
Mailing address
1436 CATHERINE ST, DECATUR, GA 30030-4505
(404) 377-0541
(404) 687-8853
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
000427
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000427
LIC.CLINICALSOCIALWORKER
GA
01
—
1000
CERTIFIEDADDICTIONCOUN II
GA
Enumeration date
04/17/2007
Last updated
07/07/2008
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