Provider Demographics
NPI:1699185173
Name:SOCIAL BUTTERFLIES YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOCIAL BUTTERFLIES YOUTH SERVICES, INC.
Other - Org Name:SOCIAL BUTTERFLIES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKEACHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:404-953-2590
Mailing Address - Street 1:124 S MAIN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3599
Mailing Address - Country:US
Mailing Address - Phone:404-491-0922
Mailing Address - Fax:866-601-5225
Practice Address - Street 1:124 S MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3599
Practice Address - Country:US
Practice Address - Phone:404-491-0922
Practice Address - Fax:866-601-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization