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General NPI Number Information
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NPI Number | 1346133436
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Entity Type | Organization
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Legal Business Name | DARE TO BE DIFFERENT INCORPORATED
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 648 MEMORIAL DR. SE,
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City | ATLANTA
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State | GA
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Zip | 30312
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Country | US
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Telephone | 770-853-0751
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Fax |
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Provider Business Mailing Address
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Address Line | 2161 CYPRESS LN SW
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City | ATLANTA
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State | GA
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Zip | 30331-5923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | THEODORE M WATSON
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Credential |
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Telephone | 770-853-0751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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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 | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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