Provider Demographics
NPI:1942248539
Name:HUMAN EXCELLENCE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:HUMAN EXCELLENCE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTORPROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OGENE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMDIV
Authorized Official - Phone:404-292-3600
Mailing Address - Street 1:778 RAYS RD
Mailing Address - Street 2:STE106
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3107
Mailing Address - Country:US
Mailing Address - Phone:404-292-3600
Mailing Address - Fax:404-299-2600
Practice Address - Street 1:778 RAYS RD
Practice Address - Street 2:STE. 106
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3107
Practice Address - Country:US
Practice Address - Phone:404-292-3600
Practice Address - Fax:404-299-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty