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General NPI Number Information
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NPI Number | 1578090601
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Entity Type | Organization
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Legal Business Name | AGAPE COMMUNITY INTEGRATED HEALTH SYSTEMS, INC
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 5536 OLD NATIONAL HWY SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30349
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Country | US
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Telephone | 404-564-4796
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Fax | 404-564-6487
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Provider Business Mailing Address
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Address Line | P.O. BOX 10938
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City | ATLANTA
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State | GA
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Zip | 30310
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Country | US
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Telephone | 404-564-6486
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Fax | 404-564-6487
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. AISHA D. FRAZIER
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Credential |
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Telephone | 404-564-6486
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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 | 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 #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community 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 | 101Y00000X
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Taxonomy Name | Counselor
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 060-435-D
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License Number State | GA
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Taxonomy #10
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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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