Provider Demographics
NPI:1942610845
Name:ADDICTION RECOVERY SERVICES
Entity Type:Organization
Organization Name:ADDICTION RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:CAC II
Authorized Official - Phone:706-594-4735
Mailing Address - Street 1:100 SMITH ST
Mailing Address - Street 2:STE #1
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2780
Mailing Address - Country:US
Mailing Address - Phone:706-594-4735
Mailing Address - Fax:706-243-4701
Practice Address - Street 1:100 SMITH ST
Practice Address - Street 2:STE #1
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2780
Practice Address - Country:US
Practice Address - Phone:706-594-4735
Practice Address - Fax:706-243-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012692101YA0400X
GALPC003428101YM0800X
GALPC002077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty