| Willow Creek Adolescent Substance Abuse Program | |
|
10 Kiker St Ellijay GA 30540-3700 | |
| (706) 636-2692 | |
| (706) 636-2694 |
| Full Name | Willow Creek Adolescent Substance Abuse Program |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 10 Kiker St, Ellijay, Georgia |
| Authorized Official Name and Position | Larry W Hooks (CEO AND DIRECTOR) |
| Authorized Official Contact | 7066362692 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Creek Adolescent Substance Abuse Program 10 Kiker St Ellijay GA 30540-3700 Ph: (706) 636-2692 | Willow Creek Adolescent Substance Abuse Program 10 Kiker St Ellijay GA 30540-3700 Ph: (706) 636-2692 |
| NPI Number | 1114174331 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 08/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114174331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LPC003706 (Georgia) | Primary |
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