Provider Demographics
NPI:1841651692
Name:THE CENTER FOR ADVANCED REHABILITATION CONCEPTS
Entity type:Organization
Organization Name:THE CENTER FOR ADVANCED REHABILITATION CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ASSOC. PROFESSIONAL COUNSE
Authorized Official - Prefix:
Authorized Official - First Name:NIKKIYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:APC
Authorized Official - Phone:404-610-2561
Mailing Address - Street 1:4473 THORNWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5394
Mailing Address - Country:US
Mailing Address - Phone:404-610-2561
Mailing Address - Fax:
Practice Address - Street 1:4473 THORNWOOD TRL
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5394
Practice Address - Country:US
Practice Address - Phone:404-610-2561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty