Provider Demographics
NPI:1184865339
Name:GREAT EXPECTATIONS UNLIMITED, LLC
Entity Type:Organization
Organization Name:GREAT EXPECTATIONS UNLIMITED, LLC
Other - Org Name:GREAT EXPECTATIONS UNLIMITED, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:202-271-2110
Mailing Address - Street 1:306 CORDER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3645
Mailing Address - Country:US
Mailing Address - Phone:478-293-4880
Mailing Address - Fax:478-293-4874
Practice Address - Street 1:309 CORDER RD, STE 1
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3645
Practice Address - Country:US
Practice Address - Phone:478-293-4880
Practice Address - Fax:478-293-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA424986876A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA424986876AMedicaid