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General NPI Number Information
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NPI Number | 1679848295
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Entity Type | Organization
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Legal Business Name | HUMANITY UNITED WITH GOD FOR SOCIETY, INC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 1203 CLEVELAND AVE SUITE 2D
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City | ATLANTA
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State | GA
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Zip | 30344-3417
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Country | US
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Telephone | 404-228-2222
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Fax | 404-228-2923
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Provider Business Mailing Address
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Address Line | 1203 CLEVELAND AVE SUITE 2D
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City | ATLANTA
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State | GA
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Zip | 30344-3417
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Country | US
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Telephone | 404-228-2222
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Fax | 404-228-2923
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Authorized Official
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Title or Position | CEO
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Name | DERRICK BILLINGSLEA
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Credential | CCT, CCS
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Telephone | 404-228-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 060-532-D
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License Number State | GA
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