Healthcare Provider Details

I. General information

NPI: 1124358692
Provider Name (Legal Business Name): OGEECHEE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 CLARKS MILL RD
LOUISVILLE GA
30434-5304
US

IV. Provider business mailing address

223 N ANDERSON DR P O BOX 1259
SWAINSBORO GA
30401-4440
US

V. Phone/Fax

Practice location:
  • Phone: 478-625-7214
  • Fax:
Mailing address:
  • Phone: 478-289-2522
  • Fax: 478-289-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA RICHBOURG
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 478-289-2522