Provider Demographics
NPI:1104190073
Name:COLLABORATIONS FOR RESILIENCY IN CHILDREN, INC
Entity Type:Organization
Organization Name:COLLABORATIONS FOR RESILIENCY IN CHILDREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MED; MA; LPC
Authorized Official - Phone:770-401-3577
Mailing Address - Street 1:2404 REFUGE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4946
Mailing Address - Country:US
Mailing Address - Phone:706-692-7209
Mailing Address - Fax:706-692-0144
Practice Address - Street 1:2404 REFUGE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4946
Practice Address - Country:US
Practice Address - Phone:706-692-7209
Practice Address - Fax:706-692-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health