Provider Demographics
NPI:1245854207
Name:AGAPE BEHAVIORAL HEALTHCARE AND COUNSELING, LLC .
Entity type:Organization
Organization Name:AGAPE BEHAVIORAL HEALTHCARE AND COUNSELING, LLC .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BENEDICTA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EJINDU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ,NCC, STC CPCS
Authorized Official - Phone:912-541-2801
Mailing Address - Street 1:3711 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0951
Mailing Address - Country:US
Mailing Address - Phone:912-541-2801
Mailing Address - Fax:
Practice Address - Street 1:3711 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0951
Practice Address - Country:US
Practice Address - Phone:912-541-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003194568AMedicaid