Provider Demographics
NPI:1417425471
Name:PROGRESSIVE TRANSITION SERVICES CORPORATION
Entity Type:Organization
Organization Name:PROGRESSIVE TRANSITION SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-665-1814
Mailing Address - Street 1:1190 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2728
Mailing Address - Country:US
Mailing Address - Phone:678-665-1814
Mailing Address - Fax:
Practice Address - Street 1:333 S 9TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4111
Practice Address - Country:US
Practice Address - Phone:770-988-4972
Practice Address - Fax:678-868-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003209316AMedicaid