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General NPI Number Information
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NPI Number | 1336480201
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Entity Type | Organization
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Legal Business Name | PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES (PROPS)
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 3400 CHAPEL HILL RD SUITE 100 PMB #08
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1739
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Country | US
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Telephone | 678-882-5371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5464
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City | DOUGLASVILLE
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State | GA
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Zip | 30154-0008
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Country | US
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Telephone | 678-882-5371
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FELICIA BERRY-MITCHELL
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Credential | PHD
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Telephone | 678-882-5371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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