Organization
DEVEREUX FOUNDATION
Active
Other names
Devereux Georgia Treatment Network
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO BOLIVAR JR. (EXECUTIVE DIRECTOR)
(687) 303-2669
Entity
Organization
Contact information
Practice address
1283 KENNESTONE CIR, SUITE 100, MARIETTA, GA 30066-6029
(678) 303-2705
Mailing address
1283 KENNESTONE CIR, SUITE 100, MARIETTA, GA 30066-6029
(678) 303-2705
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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