Provider Demographics
NPI:1144599002
Name:NORTH PINES CENTER INC
Entity Type:Organization
Organization Name:NORTH PINES CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCROGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,LMFT,LPC,CEAP
Authorized Official - Phone:770-449-1111
Mailing Address - Street 1:3355 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3009
Mailing Address - Country:US
Mailing Address - Phone:770-449-1111
Mailing Address - Fax:770-449-8113
Practice Address - Street 1:3355 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3009
Practice Address - Country:US
Practice Address - Phone:770-449-1111
Practice Address - Fax:770-449-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW000675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty