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General NPI Number Information
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NPI Number | 1841593142
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Entity Type | Organization
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Legal Business Name | COMFORT BEHAVIORAL HEALTH SOCIAL SERVICES LLC.
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 445 E. G. MILES PARKWAY SUITE # 108
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City | HINESVILLE
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State | GA
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Zip | 31313
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Country | US
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Telephone | 912-368-6822
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Fax | 912-368-6820
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Provider Business Mailing Address
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Address Line | P.O. BOX 1045 445 E. G. MILES PKWY # SUITE 108
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City | HINESVILLE
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State | GA
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Zip | 31310
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Country | US
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Telephone | 912-368-3622
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Fax | 912-368-6820
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Authorized Official
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Title or Position | CEO
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Name | MS. FUNMILAYO MEJABI
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Credential | LPC
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Telephone | 912-492-4739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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