Healthcare Provider Details

I. General information

NPI: 1609428689
Provider Name (Legal Business Name): ORCHARD HUMAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CHARLESTOWN DR
COLLEGE PARK GA
30337-3909
US

IV. Provider business mailing address

231 BENTONVILLE LN
DOUGLASVILLE GA
30134-6301
US

V. Phone/Fax

Practice location:
  • Phone: 770-686-0894
  • Fax:
Mailing address:
  • Phone: 770-686-0894
  • Fax: 770-660-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DARLEEN CLAIRE WODZENSKI
Title or Position: DIRECTOR OF PROGRAM DEVELOPMENT
Credential: PHD
Phone: 770-686-0894