Provider Demographics
NPI:1558902692
Name:DYNAMIC COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:DYNAMIC COMMUNITY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:APC
Authorized Official - Phone:404-480-2945
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-0520
Mailing Address - Country:US
Mailing Address - Phone:404-480-2945
Mailing Address - Fax:
Practice Address - Street 1:3169 SPICY CEDAR LN
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-7160
Practice Address - Country:US
Practice Address - Phone:510-322-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health