Healthcare Provider Details

I. General information

NPI: 1538887393
Provider Name (Legal Business Name): CALUMET CENTER FOR HEALING AND ATTACHMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 GREENVILLE ST
LAGRANGE GA
30241-3327
US

IV. Provider business mailing address

PO BOX 1073
LAGRANGE GA
30241-0020
US

V. Phone/Fax

Practice location:
  • Phone: 706-416-2825
  • Fax:
Mailing address:
  • Phone: 706-416-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELE BEDINGFIELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 706-302-8582