Provider Demographics
NPI:1881848174
Name:ACCESS MENTAL HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:ACCESS MENTAL HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-632-4611
Mailing Address - Street 1:PO BOX 5863
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27512
Mailing Address - Country:US
Mailing Address - Phone:919-632-4611
Mailing Address - Fax:
Practice Address - Street 1:215 LAKEWOOD WAY SW
Practice Address - Street 2:SUITE #205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315
Practice Address - Country:US
Practice Address - Phone:678-701-8978
Practice Address - Fax:888-522-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA075684824BMedicaid
GA075684824AMedicaid