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General NPI Number Information
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NPI Number | 1659023604
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Entity Type | Organization
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Legal Business Name | DOUGLASVILLE ISLAMIC WOMEN'S SHELTER AND SERVICES, INC
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 4970 WYNFORD LN
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-8012
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Country | US
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Telephone | 704-427-5400
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Fax | 470-427-5443
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Provider Business Mailing Address
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Address Line | 8486 CAMPBELLTON ST #244
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City | DOUGLASVILLE
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State | GA
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Zip | 30133
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Country | US
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Telephone | 470-427-5400
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Fax | 470-427-5443
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. NATYSHIA SMITH
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Credential | BSW, MSW
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Telephone | 470-427-5440
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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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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #5
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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Taxonomy #6
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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Taxonomy #8
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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Taxonomy #9
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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Taxonomy #10
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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Taxonomy #11
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Taxonomy Code | 333300000X
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Taxonomy Name | Emergency Response System Companies
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Taxonomy #12
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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Taxonomy #13
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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