11D2082276 CLIA NUMBER - DYNAMIC INTERVENTIONS, INC

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Laboratory Demographics

CLIA Number: 11D2082276

Facility Name: DYNAMIC INTERVENTIONS, INC

Facility Address:
524 SOUTH HOUSTON LAKE DR SUITE G-100
WARNER ROBINS, GA
ZIP 31088
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Facility Phone Number: 478 333-6197

Facility Type: Other - DRUG ABUSE TREATMENT

Certificate Type: Waiver

NPI Number: 1134262033

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	11D2082276
LAB Type	Other - DRUG ABUSE TREATMENT
Facility Name	DYNAMIC INTERVENTIONS, INC
Street	524 SOUTH HOUSTON LAKE DR SUITE G-100
City	WARNER ROBINS
State	GA
ZIP	31088
Phone	478 333-6197
CertificateType	4
CertificateEffectiveDate	8/12/2022
CertificateExpirationDate	8/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024