Provider Demographics
NPI:1326612250
Name:TRAUMA TREATMENT AND RESTORATIVE REENTRY PROGRAMS INC.
Entity Type:Organization
Organization Name:TRAUMA TREATMENT AND RESTORATIVE REENTRY PROGRAMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:JANELLE
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:718-570-3446
Mailing Address - Street 1:8341 GRADY ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6910
Mailing Address - Country:US
Mailing Address - Phone:678-653-7512
Mailing Address - Fax:
Practice Address - Street 1:700 LOMBARDY AVE APT 7413
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3368
Practice Address - Country:US
Practice Address - Phone:718-570-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty