Provider Demographics
NPI:1376213009
Name:SMALL WORLD ENRICHMENT LLC
Entity Type:Organization
Organization Name:SMALL WORLD ENRICHMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRE
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-310-5153
Mailing Address - Street 1:2032 HATTON CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9834
Mailing Address - Country:US
Mailing Address - Phone:404-429-1113
Mailing Address - Fax:
Practice Address - Street 1:4400 COLUMBIA RD STE 100
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4551
Practice Address - Country:US
Practice Address - Phone:706-310-5153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty