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General NPI Number Information
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NPI Number | 1194188532
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Entity Type | Organization
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Legal Business Name | SEEDGROW BEHAVIORAL SERVICES,LLC
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Dates
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Enumeration Date | 04/02/2016
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Last Update Date | 04/02/2016
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Provider Practice Location Address
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Address Line | 505 HEATHERDOWN WAY
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City | RIVERDALE
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State | GA
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Zip | 30274-3592
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Country | US
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Telephone | 678-435-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 505 HEATHERDOWN WAY
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City | RIVERDALE
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State | GA
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Zip | 30274-3592
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Country | US
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Telephone | 678-435-9214
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | STEPHANIE KNOX
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Credential | BCBA
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Telephone | 404-565-6029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 01-14-17610
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License Number State | GA
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