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PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES LLC NPI 1215357272


NPI Information

NPI: 1215357272
Provider Name: PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC

Doing Business As: PROPS

Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
6576 CHURCH ST
DOUGLASVILLE, GA
ZIP 30134
Phone: (770) 577-7873
Get Directions

PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC is a clinical psychologist in Douglasville, GA. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC NPI is 1215357272. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Props.

The provider's business location address is:

6576 CHURCH ST
DOUGLASVILLE, GA
ZIP 30134-884
Phone: (770) 577-7873
Fax: (770) 577-7871

The provider's authorized official is Felicia Berry-mitchell .
The authorized official title is President and has the following contact phone number (770) 577-7873.

The enumeration date for this NPI number is 4/17/2014 and was last updated on 4/17/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101Y00000XCounselorNo
2101YA0400XCounselorAddiction (Substance Use Disorder)No
3101YP2500XCounselorProfessionalNo
4104100000XSocial WorkerNo
51041C0700XSocial WorkerClinicalNo
6106H00000XMarriage & Family TherapistNo
7133N00000XNutritionistNo
8136A00000XDietetic Technician, RegisteredNo
9163WP0808XRegistered NursePsychiatric/Mental HealthNo
10164W00000XLicensed Practical NurseNo
11171100000XAcupuncturistNo
12171M00000XCase Manager/Care CoordinatorNo
132084P0800XPsychiatry & NeurologyPsychiatryNo
14374700000XTechnicianNo
15103TC0700XPsychologistClinicalPSY003237GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1003132073BMEDICAIDGEORGIA
22021689608MEDICARE UPINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.