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General NPI Number Information
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NPI Number | 1740535962
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Entity Type | Organization
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Legal Business Name | SOCIAL SERVICES INSTITUTE, LLC
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Dates
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Enumeration Date | 07/14/2012
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Last Update Date | 07/14/2012
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Provider Practice Location Address
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Address Line | 4581 DURON PL SW
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City | MABLETON
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State | GA
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Zip | 30126-1177
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Country | US
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Telephone | 770-944-7280
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Fax | 770-944-7280
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Provider Business Mailing Address
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Address Line | PO BOX 1821
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City | MABLETON
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State | GA
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Zip | 30126-1013
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Country | US
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Telephone | 770-944-7280
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Fax | 770-944-7280
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | HENRY EARL ROBERSON
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Credential | LCSW
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Telephone | 770-944-7280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | CSW001776
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CSW001776
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | CSW001776
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | CSW001776
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License Number State | GA
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