Healthcare Provider Details

I. General information

NPI: 1841593142
Provider Name (Legal Business Name): COMFORT BEHAVIORAL HEALTH SOCIAL SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E. G. MILES PARKWAY SUITE # 108
HINESVILLE GA
31313
US

IV. Provider business mailing address

P.O. BOX 1045 445 E. G. MILES PKWY # SUITE 108
HINESVILLE GA
31310
US

V. Phone/Fax

Practice location:
  • Phone: 912-368-6822
  • Fax: 912-368-6820
Mailing address:
  • Phone: 912-368-3622
  • Fax: 912-368-6820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. FUNMILAYO MEJABI
Title or Position: CEO
Credential: LPC
Phone: 912-492-4739