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General NPI Number Information
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NPI Number | 1215682471
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 12461 VETERANS MEMORIAL HWY STE 775
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2025
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Country | US
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Telephone | 770-873-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 4471 GLIDER CIR
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-8722
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Country | US
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Telephone | 770-873-4840
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN NEWSOME
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Credential | LPC
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Telephone | 770-873-4840
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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 |
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License Number State |
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