11D2316623 CLIA NUMBER - THE EXTENSION INC

Laboratory Demographics

  • CLIA Code: 11D2316623
  • Facility Name: THE EXTENSION INC
  • Facility Address: 1507 CHURCH STREET EXT
    MARIETTA, GA
    ZIP 30060
  • Facility Phone: 770 590-9075
  • Facility Type: Other - RES TREATMENT FACILITY
  • Facility Type: Waiver
  • Lab Director: MARY JEAN MILLIKAN
  • NPI Number: 1730756719
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 11D2316623
LAB Type Other - RES TREATMENT FACILITY
Facility Name THE EXTENSION INC
Street 1507 CHURCH STREET EXT
City MARIETTA
State GA
ZIP 30060
Phone 770 590-9075
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2025
Certificate Expiration Date 1/8/2027
Facility Type Other - RES TREATMENT FACILITY
Lab Director MARY JEAN MILLIKAN

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This page was last updated on: 9/29/2025