Provider Demographics
NPI:1578193835
Name:STABILITY REBOOTED, LLC
Entity Type:Organization
Organization Name:STABILITY REBOOTED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ICAADC, ARBS II
Authorized Official - Phone:470-532-1721
Mailing Address - Street 1:5833 STEWART PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6933
Mailing Address - Country:US
Mailing Address - Phone:844-782-2454
Mailing Address - Fax:833-782-2329
Practice Address - Street 1:5833 STEWART PKWY STE 103
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6933
Practice Address - Country:US
Practice Address - Phone:844-782-2454
Practice Address - Fax:833-782-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty