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General NPI Number Information
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NPI Number | 1861931172
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Entity Type | Organization
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Legal Business Name | GEORGIA BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 104 BORDERS WAY STE 500
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8967
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Country | US
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Telephone | 478-352-0422
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Fax | 888-813-6815
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Provider Business Mailing Address
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Address Line | 104 BORDERS WAY STE 500
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8967
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Country | US
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Telephone | 910-689-5190
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARLA NICOLE JACKSON
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Credential | CADC II, SAP
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Telephone | 478-352-0422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1083
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License Number State | GA
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