Basic Information
| Provider Information | |||||||||
| NPI: | 1801305354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE DECISION TREE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1114 HWY 96 | ||||||||
| Address2: | SUITE C-1, BOX 309 | ||||||||
| City: | KATHLEEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125208084 | ||||||||
| FaxNumber: | 4785514718 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 CORDER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785514714 | ||||||||
| FaxNumber: | 4785514718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | KINLAW | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | MONTAGUE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 9125208084 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE DECISION TREE, LLC | ||||||||
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| AuthorizedOfficialCredential: | LCSW, MAC | ||||||||
| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | CSW004819 | GA | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.