Provider Demographics
NPI:1053473405
Name:SUPPORTED EMPLOYMENT SPECIALISTS
Entity Type:Organization
Organization Name:SUPPORTED EMPLOYMENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANNA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-499-2172
Mailing Address - Street 1:615 ROSWELL ST NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2196
Mailing Address - Country:US
Mailing Address - Phone:770-499-2172
Mailing Address - Fax:678-354-2670
Practice Address - Street 1:615 ROSWELL ST NE
Practice Address - Street 2:SUITE 110
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2196
Practice Address - Country:US
Practice Address - Phone:770-499-2172
Practice Address - Fax:678-354-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services