POSITIVE IMPACT RESIDENTIAL SERVICES NPI 1487079562

NPI Information

NPI: 1487079562
Provider Name: POSITIVE IMPACT RESIDENTIAL SERVICES
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
2189 W PONCE DE LEON AVE
DECATUR, GA
ZIP 30030
Phone: (678) 887-3263
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POSITIVE IMPACT RESIDENTIAL SERVICES is a mental health (including community mental health center) clinic center in Decatur, GA. POSITIVE IMPACT RESIDENTIAL SERVICES NPI is 1487079562. The provider is registered as an organization entity type.

The provider's business location address is:

2189 W PONCE DE LEON AVE
DECATUR, GA
ZIP 30030-334
Phone: (678) 887-3263
Fax: (404) 687-9871

The provider's authorized official is Wax Flowers .
The authorized official title is Lcsw/owner and has the following contact phone number (866) 730-7604.

The enumeration date for this NPI number is 2/25/2014 and was last updated on 2/25/2014.

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
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	CSW002378	GEORGIA	Yes

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: 4/28/2024

NPI Synchronization or Removal

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