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General NPI Number Information
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NPI Number | 1770754079
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Entity Type | Organization
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Legal Business Name | NEW HAVEN COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 26 CANNONGATE RD SUITE 2
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City | SHARPSBURG
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State | GA
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Zip | 30277-1544
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Country | US
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Telephone | 404-916-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 26 CANNONGATE RD SUITE 2
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City | SHARPSBURG
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State | GA
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Zip | 30277-1544
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Country | US
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Telephone | 404-916-0681
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MABLE OVERTON
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Credential | LPC
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Telephone | 404-916-0681
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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 | LPC004026
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License Number State | GA
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