Provider Demographics
NPI:1154031672
Name:SAMATRA SA COUNSELING, EDUCATION AND TRAININGS
Entity type:Organization
Organization Name:SAMATRA SA COUNSELING, EDUCATION AND TRAININGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMATRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MAC, ICAADC
Authorized Official - Phone:404-838-1271
Mailing Address - Street 1:4868 OZMENT TRL
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6208
Mailing Address - Country:US
Mailing Address - Phone:404-838-1271
Mailing Address - Fax:
Practice Address - Street 1:1000 IRIS DR SW # 200D
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6632
Practice Address - Country:US
Practice Address - Phone:404-838-1271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility