Provider Demographics
NPI:1871008425
Name:SURVIVAL 2 VICTORY, INC.
Entity Type:Organization
Organization Name:SURVIVAL 2 VICTORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:678-871-6543
Mailing Address - Street 1:3579A CHAMBLEE TUCKER RD
Mailing Address - Street 2:# 941245
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31141
Mailing Address - Country:US
Mailing Address - Phone:678-871-6543
Mailing Address - Fax:
Practice Address - Street 1:3579 CHAMBLEE TUCKER RD UNIT 941245A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:31141-1009
Practice Address - Country:US
Practice Address - Phone:678-871-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health