Healthcare Provider Details

I. General information

NPI: 1851520803
Provider Name (Legal Business Name): BETHANY CHRISTIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30328-1606
US

IV. Provider business mailing address

6645 PEACHTREE DUNWOODY RD NE
ATLANTA GA
30328-1606
US

V. Phone/Fax

Practice location:
  • Phone: 770-455-7111
  • Fax: 770-455-7118
Mailing address:
  • Phone: 770-455-7111
  • Fax: 770-455-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW003659
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HELEN RENFROE
Title or Position: LCSW
Credential:
Phone: 770-274-3462