Provider Demographics
NPI:1235736182
Name:THINK BIG YOUTH ORGANIZATION LLC
Entity Type:Organization
Organization Name:THINK BIG YOUTH ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMMENTRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-610-3466
Mailing Address - Street 1:9784 E OGLETHORPE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-4546
Mailing Address - Country:US
Mailing Address - Phone:912-610-3466
Mailing Address - Fax:
Practice Address - Street 1:9784 E OGLETHORPE HWY STE C
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-4546
Practice Address - Country:US
Practice Address - Phone:912-610-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020OtherCOUNSELING SERVICES