Healthcare Provider Details

I. General information

NPI: 1629506787
Provider Name (Legal Business Name): COMPASSIONATE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 SHIRLEY AVE
DOUGLAS GA
31533-2002
US

IV. Provider business mailing address

408 SHIRLEY AVE
DOUGLAS GA
31533-2002
US

V. Phone/Fax

Practice location:
  • Phone: 912-292-1177
  • Fax: 912-292-0241
Mailing address:
  • Phone: 912-292-1177
  • Fax: 912-292-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005528
License Number StateGA

VIII. Authorized Official

Name: SARA E ATKINSON
Title or Position: OWNER
Credential: LCSW
Phone: 912-381-2504