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General NPI Number Information
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NPI Number | 1629694120
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Entity Type | Organization
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Legal Business Name | CLAYTON COUNTY JUVENILE JUSTICE FUND
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 1412 SOUTHLAKE PLAZA DR
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City | MORROW
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State | GA
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Zip | 30260-1756
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Country | US
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Telephone | 770-703-6675
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 SOUTHLAKE PLAZA DR
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City | MORROW
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State | GA
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Zip | 30260-1756
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Country | US
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Telephone | 770-703-6675
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DEBORAH STONE
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Credential |
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Telephone | 734-392-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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