Provider Demographics
NPI:1417456898
Name:ROYAL COURT OF ESTHER INC
Entity Type:Organization
Organization Name:ROYAL COURT OF ESTHER INC
Other - Org Name:ESTHER FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYSHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:470-441-5220
Mailing Address - Street 1:375 BARSHAY DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-0968
Mailing Address - Country:US
Mailing Address - Phone:470-441-5220
Mailing Address - Fax:
Practice Address - Street 1:2365 WALL ST SE STE 200-05
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2197
Practice Address - Country:US
Practice Address - Phone:470-441-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL COURT OF ESTHER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)