Provider Demographics
NPI:1881035194
Name:PABS UNLIMITED, INC
Entity Type:Organization
Organization Name:PABS UNLIMITED, INC
Other - Org Name:PABS FAMILYCOUNSELNG AND INTERVENTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, EDS
Authorized Official - Phone:770-969-4309
Mailing Address - Street 1:4405 MALL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2071
Mailing Address - Country:US
Mailing Address - Phone:770-969-4309
Mailing Address - Fax:770-969-4170
Practice Address - Street 1:4405 MALL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2071
Practice Address - Country:US
Practice Address - Phone:770-969-4309
Practice Address - Fax:770-969-4170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006366302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA49440073AMedicaid