Provider Demographics
NPI:1497922801
Name:STONEBRAKER'S, INC
Entity Type:Organization
Organization Name:STONEBRAKER'S, INC
Other - Org Name:THE INSIGHT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STONEBRAKER
Authorized Official - Suffix:
Authorized Official - Credentials:ICCS, ICADC, CAC II,
Authorized Official - Phone:770-751-8383
Mailing Address - Street 1:5110 OLD ELLIS PT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3863
Mailing Address - Country:US
Mailing Address - Phone:770-751-8383
Mailing Address - Fax:770-751-7282
Practice Address - Street 1:5110 OLD ELLIS PT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3863
Practice Address - Country:US
Practice Address - Phone:770-751-8383
Practice Address - Fax:770-751-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028-556-D101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty