Provider Demographics
NPI:1578859781
Name:GEORGIA COMMUNITY-BASED LEARNING FOR AT-RISK YOUTH
Entity Type:Organization
Organization Name:GEORGIA COMMUNITY-BASED LEARNING FOR AT-RISK YOUTH
Other - Org Name:GEORGIA C.L.A.Y.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:VANDIVER
Authorized Official - Last Name:MCGARITY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:706-207-6181
Mailing Address - Street 1:425 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3809
Practice Address - Country:US
Practice Address - Phone:706-207-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-26
Last Update Date:2011-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management