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General NPI Number Information
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NPI Number | 1518396548
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH CRISIS CENTER
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 3116 NORTH OAK STREET EXT
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City | VALDOSTA
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State | GA
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Zip | 31602-5910
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Country | US
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Telephone | 229-671-6100
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Fax | 229-671-6774
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Provider Business Mailing Address
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Address Line | 3120 N OAK STREET EXT STE C
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City | VALDOSTA
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State | GA
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Zip | 31602-5910
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Country | US
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Telephone | 229-671-6100
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Fax | 229-671-6774
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Authorized Official
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Title or Position | CFO
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Name | MRS. STEFANIE JACKSON
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Credential | CFO
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Telephone | 229-671-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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