Provider Demographics
NPI:1457584054
Name:SOUTH EAST BEHAVIORAL COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:SOUTH EAST BEHAVIORAL COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ACSW, MAC, SAP
Authorized Official - Phone:706-364-8683
Mailing Address - Street 1:1725 MILL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-4083
Mailing Address - Country:US
Mailing Address - Phone:706-364-8683
Mailing Address - Fax:706-364-7218
Practice Address - Street 1:1725 MILL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-4083
Practice Address - Country:US
Practice Address - Phone:706-364-8683
Practice Address - Fax:706-364-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002457251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health