=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255828612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORKING CONCEPTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2018
-----------------------------------------------------
Last Update Date | 04/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 HABERSHAM DR STE 325
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-371-5171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 HABERSHAM DR STE 325
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEPHANIE HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-371-5171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | RN057486
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LPC007681
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------