Provider Demographics
NPI:1093465056
Name:CENTER FOR MENTAL AND SPIRITUAL HEALTH
Entity Type:Organization
Organization Name:CENTER FOR MENTAL AND SPIRITUAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT/S
Authorized Official - Phone:706-250-2653
Mailing Address - Street 1:906 HUNTING HORN WAY W
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4828
Mailing Address - Country:US
Mailing Address - Phone:706-993-7220
Mailing Address - Fax:
Practice Address - Street 1:4325 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3966
Practice Address - Country:US
Practice Address - Phone:706-993-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)