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General NPI Number Information
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NPI Number | 1275426454
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Entity Type | Organization
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Legal Business Name | CSA PSYCHIATRIC HEALING CENTER LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 327 W MAIN ST
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City | THOMASTON
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State | GA
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Zip | 30286-3502
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Country | US
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Telephone | 404-621-4535
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Fax |
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Provider Business Mailing Address
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Address Line | 17 HAMPTON ST STE E
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City | MCDONOUGH
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State | GA
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Zip | 30253-3159
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Country | US
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Telephone | 404-621-4535
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Fax | 404-621-4535
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DAISOPHIA HARPER
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Credential | MSN, APRN, PMHNP
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Telephone | 404-621-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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