Provider Demographics
NPI:1164774741
Name:OPERATION J.U.M.P., INC.
Entity Type:Organization
Organization Name:OPERATION J.U.M.P., INC.
Other - Org Name:COMPREHENSIVE COUNSELING SERVICES @ CHASTITY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-767-5554
Mailing Address - Street 1:2622 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6738
Mailing Address - Country:US
Mailing Address - Phone:404-767-5554
Mailing Address - Fax:
Practice Address - Street 1:2622 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6738
Practice Address - Country:US
Practice Address - Phone:404-767-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006041251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health