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Contact Information

PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC
6576 CHURCH ST
DOUGLASVILLE, GA30134-1884
 Phone: 770-577-7873
 Fax: 770-577-7871
 Website:
Indicates primary specialty

NPI Profile & details for PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC

NPI # 1215357272
LBN Legal business name PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC
Authorized official FELICIA BERRY-MITCHELL - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 04/17/2014
Last updated 04/17/2014 - About 12 years ago
Identifiers
GA License # PSY003237
GA Medicaid 003132073B
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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