Provider Demographics
NPI:1245696723
Name:VILLAGE HEALTH INITIATIVE
Entity type:Organization
Organization Name:VILLAGE HEALTH INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERLESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARUTH
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, C-MFT
Authorized Official - Phone:678-480-8302
Mailing Address - Street 1:386 PINE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 PINE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2532
Practice Address - Country:US
Practice Address - Phone:678-480-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty