Provider Demographics
NPI:1689939076
Name:MENTORING AND BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:MENTORING AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-587-8986
Mailing Address - Street 1:7000 STORAGE CT
Mailing Address - Street 2:SUITE 22
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-0700
Mailing Address - Country:US
Mailing Address - Phone:706-587-8986
Mailing Address - Fax:706-221-5819
Practice Address - Street 1:7000 STORAGE CT
Practice Address - Street 2:SUITE 22
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-0700
Practice Address - Country:US
Practice Address - Phone:706-587-8986
Practice Address - Fax:706-221-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108544251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health