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General NPI Number Information
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NPI Number | 1366794315
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Entity Type | Organization
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Legal Business Name | BOSS UNITED, INC.
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 22 WESTWICK PL
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-4836
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Country | US
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Telephone | 404-713-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 22 WESTWICK PL
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-4836
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Country | US
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Telephone | 404-713-7050
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BARRY O.C. FRAZIER
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Credential | LPC
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Telephone | 404-713-7050
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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 | LPC006754
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License Number State | GA
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