Provider Demographics
NPI:1477203347
Name:THE SAFETY NET YOUTH SERVICES
Entity Type:Organization
Organization Name:THE SAFETY NET YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:ICAADC
Authorized Official - Phone:470-321-3346
Mailing Address - Street 1:PO BOX 465472
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-5472
Mailing Address - Country:US
Mailing Address - Phone:470-321-3346
Mailing Address - Fax:
Practice Address - Street 1:3416 TIMBERCREEK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3050
Practice Address - Country:US
Practice Address - Phone:470-321-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty