Provider Demographics
NPI:1528400926
Name:PROGRESSIVE CARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE CARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-574-8313
Mailing Address - Street 1:3415 OLD HIGHWAY 41
Mailing Address - Street 2:SUITE 750
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1028
Mailing Address - Country:US
Mailing Address - Phone:678-574-8313
Mailing Address - Fax:678-574-8315
Practice Address - Street 1:3415 OLD HIGHWAY 41
Practice Address - Street 2:SUITE 750
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1028
Practice Address - Country:US
Practice Address - Phone:678-574-8313
Practice Address - Fax:678-574-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU0043161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty