Provider Demographics
NPI:1952825531
Name:CW EDUCATIONAL AND BEHAVIORAL
Entity Type:Organization
Organization Name:CW EDUCATIONAL AND BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL-CONSTANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-613-1242
Mailing Address - Street 1:2867 COUNTRY HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7647
Mailing Address - Country:US
Mailing Address - Phone:678-613-1242
Mailing Address - Fax:
Practice Address - Street 1:7163 NADIR HOMES
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1525
Practice Address - Country:US
Practice Address - Phone:678-613-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005918101YM0800X
GA444521251300000X, 252Y00000X, 261QD1600X
GAAPC0005918251S00000X, 261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty