Organization
THE EXTENSION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GLOVER (DIRECTOR OF ADMINISTRATION)
(770) 590-9075
Entity
Organization
Contact information
Practice address
1507 CHURCH STREET EXT NE, MARIETTA, GA 30060-1023
(770) 590-9075
Mailing address
1507 CHURCH STREET EXT NE, MARIETTA, GA 30060-1023
(770) 590-9075
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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