Healthcare Provider Details

I. General information

NPI: 1952825531
Provider Name (Legal Business Name): CW EDUCATIONAL AND BEHAVIORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7163 NADIR HOMES
ST THOMAS VI
00802-1525
US

IV. Provider business mailing address

2867 COUNTRY HOUSE LN
BUFORD GA
30519-7647
US

V. Phone/Fax

Practice location:
  • Phone: 678-613-1242
  • Fax:
Mailing address:
  • Phone: 678-613-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number444521
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberAPC0005918
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number444521
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number444521
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberAPC0005918
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAPC0005918
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC005918
License Number StateGA

VIII. Authorized Official

Name: DR. VINCENTIA PAUL-CONSTANTIN
Title or Position: DIRECTOR
Credential: PHD
Phone: 678-613-1242