Provider Demographics
NPI:1427368539
Name:UNISON BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:UNISON BEHAVIORAL HEALTH
Other - Org Name:CLINCH C&A
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-449-7103
Mailing Address - Street 1:1007 MARY ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-3823
Mailing Address - Country:US
Mailing Address - Phone:912-449-7109
Mailing Address - Fax:912-449-7056
Practice Address - Street 1:551 OLD PEARSON RD
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-1724
Practice Address - Country:US
Practice Address - Phone:912-449-7109
Practice Address - Fax:912-449-7056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNISON BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606295HMedicaid