| Douglas County Community Services Board | |
|
5274 Big A Rd Douglasville GA 30135-5308 | |
| (770) 920-0717 | |
| Not Available |
| Full Name | Douglas County Community Services Board |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5274 Big A Rd, Douglasville, Georgia |
| Authorized Official Name and Position | Tod Citron (CEO) |
| Authorized Official Contact | 7704295000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas County Community Services Board 3830 S Cobb Dr Se Suite 300 Smyrna GA 30080-5532 Ph: (770) 429-5000 | Douglas County Community Services Board 5274 Big A Rd Douglasville GA 30135-5308 Ph: (770) 920-0717 |
| NPI Number | 1720128879 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0143653014 |
|---|---|
| Medicare Enrollment ID | O20191206001032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720128879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Teresa P Lane |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1770638397 PECOS PAC ID: 8729035282 Enrollment ID: I20050408000367 |
| Provider Name | Teresa P Lane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770638397 PECOS PAC ID: 8729035282 Enrollment ID: I20090224000413 |
| Provider Name | Edward Ajayi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285649707 PECOS PAC ID: 9032383112 Enrollment ID: I20111130000136 |
| Provider Name | Joseph K Obuba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043630627 PECOS PAC ID: 6709002967 Enrollment ID: I20140723002167 |
| Provider Name | Nabila Z Haque |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720252240 PECOS PAC ID: 1759718646 Enrollment ID: I20200306000256 |
The Sister Circle Of Love And Empowerment Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4706 Boyer Glen Dr., Douglasville, GA 30135 Phone: 770-896-6854 | |
Reflections Behavioral Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2860 Saddle Bronc Cir, Douglasville, GA 30135 Phone: 877-221-6843 | |
Change Your Story Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8336 Office Park Dr Ste Office, Douglasville, GA 30134 Phone: 770-568-7650 | |
Life Tools Community Development Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5357 Chapel Hill Rd, Douglasville, GA 30135 Phone: 770-942-4742 Fax: 770-293-0786 | |
Real Life Solutions Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 8355 Cherokee Blvd, Douglasville, GA 30134 Phone: 770-927-7272 | |
Douglasville Psychological Outpatient Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8304 Office Park Dr, Douglasville, GA 30134 Phone: 678-838-9336 | |
Holistic Solutions Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2110 Fairburn Rd Ste C, Douglasville, GA 30135 Phone: 770-880-2294 |