Provider Demographics
NPI:1922623644
Name:SKIDAWAY BEHAVIORAL INSTITUTE LLC
Entity Type:Organization
Organization Name:SKIDAWAY BEHAVIORAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIRSOL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PSYD
Authorized Official - Phone:912-401-3990
Mailing Address - Street 1:3 CHATUACHEE XING
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-1602
Mailing Address - Country:US
Mailing Address - Phone:912-401-3990
Mailing Address - Fax:
Practice Address - Street 1:3 CHATUACHEE XING
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-1602
Practice Address - Country:US
Practice Address - Phone:912-401-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty