Provider Demographics
NPI:1518932078
Name:CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARD
Entity Type:Organization
Organization Name:CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARD
Other - Org Name:CLAYTON CENTER CSB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUNDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-478-2280
Mailing Address - Street 1:157 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3546
Mailing Address - Country:US
Mailing Address - Phone:770-478-2280
Mailing Address - Fax:770-477-9772
Practice Address - Street 1:157 SMITH ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3546
Practice Address - Country:US
Practice Address - Phone:770-478-2280
Practice Address - Fax:770-477-9772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-20
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00606922ABMedicaid
GA00606922ABMedicaid