Provider Demographics
NPI:1922353549
Name:ADOLESCENT ADVOCACY CENTER
Entity Type:Organization
Organization Name:ADOLESCENT ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAA DZAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODDOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-525-0966
Mailing Address - Street 1:312 RIMINGTON LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2134
Mailing Address - Country:US
Mailing Address - Phone:678-404-6733
Mailing Address - Fax:
Practice Address - Street 1:312 RIMINGTON LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2134
Practice Address - Country:US
Practice Address - Phone:678-404-6733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness