Organization
MCINTOSH TRAIL CSB
Active
Organization
MCINTOSH TRAIL CSB
Active
Other names
Henry DD Service Center
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE HUBBARD LCSW (CEO)
(770) 358-8251
Entity
Organization
Contact information
Practice address
672 INDUSTRIAL BLVD, MCDONOUGH, GA 30253-6611
(770) 358-8258
(770) 229-3223
Mailing address
1435 N EXPRESSWAY, SUITE 301, GRIFFIN, GA 30223-9016
(770) 358-8250
(770) 229-3223
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000603435F
—
GA
05
—
000603435N
—
GA
Enumeration date
02/13/2008
Last updated
12/17/2015
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