Provider Demographics
NPI:1225253354
Name:ETHEL'S PLACE, INC.
Entity Type:Organization
Organization Name:ETHEL'S PLACE, INC.
Other - Org Name:THE GUSSIE WILLIAMS COMMUNITY RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-858-6283
Mailing Address - Street 1:302 W I PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5061
Mailing Address - Country:US
Mailing Address - Phone:678-363-3799
Mailing Address - Fax:
Practice Address - Street 1:302 W I PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5061
Practice Address - Country:US
Practice Address - Phone:678-363-3799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty