Provider Demographics
NPI:1740535962
Name:SOCIAL SERVICES INSTITUTE, LLC
Entity type:Organization
Organization Name:SOCIAL SERVICES INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-944-7280
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1013
Mailing Address - Country:US
Mailing Address - Phone:770-944-7280
Mailing Address - Fax:770-944-7280
Practice Address - Street 1:4581 DURON PL SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1177
Practice Address - Country:US
Practice Address - Phone:770-944-7280
Practice Address - Fax:770-944-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW001776251300000X, 251B00000X, 252Y00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care