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General NPI Number Information
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NPI Number | 1689996787
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Entity Type | Organization
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Legal Business Name | UPLIFTING THE COMMUNITY, INC
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 724 LAUREN PKWY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-3482
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Country | US
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Telephone | 678-510-7220
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Fax | 678-510-7223
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Provider Business Mailing Address
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Address Line | 1151 CLEVELAND AVE SUITE A
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City | EAST POINT
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State | GA
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Zip | 30344-3600
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Country | US
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Telephone | 404-684-0868
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Fax | 404-684-0871
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ADRIAN VERWAYNE
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Credential |
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Telephone | 404-684-0868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 00220107
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License Number State | GA
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