Provider Demographics
NPI:1811433386
Name:STONEBRAKER'S INC.
Entity type:Organization
Organization Name:STONEBRAKER'S INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-889-9504
Mailing Address - Street 1:5110 OLD ELLIS POINT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-751-8383
Mailing Address - Fax:
Practice Address - Street 1:920 BLAIRHILL RD
Practice Address - Street 2:STE B-103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1565
Practice Address - Country:US
Practice Address - Phone:704-679-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEBRAKER'S INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-1253101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty