Provider Demographics
NPI:1144588682
Name:I CARE MENTAL HEALTH INC.
Entity Type:Organization
Organization Name:I CARE MENTAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AGBOOLA
Authorized Official - Last Name:ABOLARIN
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:404-429-7173
Mailing Address - Street 1:2591 MACON DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-8305
Mailing Address - Country:US
Mailing Address - Phone:404-762-7904
Mailing Address - Fax:404-768-4205
Practice Address - Street 1:2591 MACON DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-8305
Practice Address - Country:US
Practice Address - Phone:404-762-7904
Practice Address - Fax:404-768-4205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I CARE MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003377251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGEORGIAMedicaid