Provider Demographics
NPI:1558713479
Name:SAFE PLACE ATLANTA
Entity Type:Organization
Organization Name:SAFE PLACE ATLANTA
Other - Org Name:SAFE PLACE ATLANTA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PILAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-431-7092
Mailing Address - Street 1:6612 PAMPLONA PL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8491
Mailing Address - Country:US
Mailing Address - Phone:404-431-7092
Mailing Address - Fax:
Practice Address - Street 1:6612 PAMPLONA PL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-8491
Practice Address - Country:US
Practice Address - Phone:404-431-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty