Provider Demographics
NPI:1679728554
Name:GREENLEE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GREENLEE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-354-4402
Mailing Address - Street 1:7350 CAMPBELLTON RD SW
Mailing Address - Street 2:SUITE 319
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8176
Mailing Address - Country:US
Mailing Address - Phone:404-354-4402
Mailing Address - Fax:
Practice Address - Street 1:7350 CAMPBELLTON RD SW
Practice Address - Street 2:SUITE 319
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8176
Practice Address - Country:US
Practice Address - Phone:404-354-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty