Provider Demographics
NPI:1497977003
Name:THE HUMAN REDISCOVERY CENTER
Entity Type:Organization
Organization Name:THE HUMAN REDISCOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OGENE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC,MDIV
Authorized Official - Phone:404-292-3600
Mailing Address - Street 1:778 RAYS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3107
Mailing Address - Country:US
Mailing Address - Phone:404-292-3600
Mailing Address - Fax:404-297-2600
Practice Address - Street 1:778 RAYS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3107
Practice Address - Country:US
Practice Address - Phone:404-292-3600
Practice Address - Fax:404-297-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003621103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty