Provider Demographics
NPI:1033435482
Name:TRAIME BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:TRAIME BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-419-0222
Mailing Address - Street 1:2020 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE C213
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1732
Mailing Address - Country:US
Mailing Address - Phone:678-419-0222
Mailing Address - Fax:
Practice Address - Street 1:2020 HOWELL MILL RD NW
Practice Address - Street 2:SUITE C213
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1732
Practice Address - Country:US
Practice Address - Phone:678-419-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA913993685AMedicaid