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General NPI Number Information
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NPI Number | 1740503242
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Entity Type | Organization
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Legal Business Name | MARIBILL BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 2385 WALL ST SE
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City | CONYERS
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State | GA
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Zip | 30013-2187
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Country | US
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Telephone | 770-891-2170
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Fax |
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Provider Business Mailing Address
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Address Line | 2385 WALL ST SE
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City | CONYERS
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State | GA
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Zip | 30013-2187
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Country | US
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Telephone | 770-891-2170
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. WILLIAM THOMAS
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Credential | PH.D., ICADC
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Telephone | 770-891-2170
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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 | 10018261
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License Number State | GA
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