11D2212624 CLIA NUMBER - GEORGIA BEHAVIORAL SERVICES,LLC

Laboratory Demographics

CLIA Number: 11D2212624

Facility Name: GEORGIA BEHAVIORAL SERVICES,LLC

Facility Address:
104 BORDERS WAY SUITE 500
WARNER ROBINS, GA
ZIP 31088
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Facility Phone Number: 478 352-0422

Facility Type: Other - DATEP

Certificate Type: Waiver

NPI Number: 1861931172

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	11D2212624
LAB Type	Other - DATEP
Facility Name	GEORGIA BEHAVIORAL SERVICES,LLC
Street	104 BORDERS WAY SUITE 500
City	WARNER ROBINS
State	GA
ZIP	31088
Phone	478 352-0422
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024