| Life Intervention Network Center | |
|
2551 River Forest Ct Ellenwood GA 30294-1270 | |
| (850) 264-5745 | |
| Not Available |
| Full Name | Life Intervention Network Center |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2551 River Forest Ct, Ellenwood, Georgia |
| Authorized Official Name and Position | Kelvin Brown (MENTAL HEALTH/SUBSTANCE ABUSE COUNS) |
| Authorized Official Contact | 8502645745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Intervention Network Center Po Box 360975 Decatur GA 30036-0975 Ph: (850) 264-5745 | Life Intervention Network Center 2551 River Forest Ct Ellenwood GA 30294-1270 Ph: (850) 264-5745 |
| NPI Number | 1588059232 |
|---|---|
| Provider Enumeration Date | 03/31/2015 |
| Last Update Date | 03/31/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588059232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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