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General NPI Number Information
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NPI Number | 1891859377
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Entity Type | Organization
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Legal Business Name | GRN CSB
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 977A TAYLOR ST SW
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City | CONYERS
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State | GA
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Zip | 30012-5357
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Country | US
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Telephone | 770-918-6677
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Fax | 770-918-6686
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Provider Business Mailing Address
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Address Line | 977A TAYLOR ST SW
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City | CONYERS
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State | GA
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Zip | 30012-5357
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Country | US
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Telephone | 770-918-6677
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Fax | 770-918-6686
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | FALESHA ROBINSON
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Credential |
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Telephone | 770-918-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CSW003703
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License Number State | GA
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