Provider Demographics
NPI:1295032126
Name:PEACEWERKS CENTER FOR WELL-BEING
Entity Type:Organization
Organization Name:PEACEWERKS CENTER FOR WELL-BEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:POLLY
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-296-8687
Mailing Address - Street 1:5420 RED BERRY LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7750
Mailing Address - Country:US
Mailing Address - Phone:678-296-8687
Mailing Address - Fax:
Practice Address - Street 1:5420 RED BERRY LN SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7750
Practice Address - Country:US
Practice Address - Phone:678-296-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty