Provider Demographics
NPI:1821641382
Name:SOUTHEAST ARTS ASSOCIATION
Entity Type:Organization
Organization Name:SOUTHEAST ARTS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-554-1092
Mailing Address - Street 1:477 VILLAGE SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4274
Mailing Address - Country:US
Mailing Address - Phone:251-554-1092
Mailing Address - Fax:
Practice Address - Street 1:477 VILLAGE SQUARE CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-4274
Practice Address - Country:US
Practice Address - Phone:251-554-1092
Practice Address - Fax:404-465-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase Management