Provider Demographics
NPI:1851768329
Name:GOOD SAMARITAN BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:912-348-3486
Mailing Address - Street 1:138 CANAL ST
Mailing Address - Street 2:UNIT 307
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4051
Mailing Address - Country:US
Mailing Address - Phone:912-348-3486
Mailing Address - Fax:
Practice Address - Street 1:138 CANAL ST
Practice Address - Street 2:UNIT 307
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4051
Practice Address - Country:US
Practice Address - Phone:912-348-3486
Practice Address - Fax:912-348-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty