Provider Demographics
NPI:1750602173
Name:DEKALB RAPE CRISIS CENTER INC
Entity type:Organization
Organization Name:DEKALB RAPE CRISIS CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:WARDRETT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:404-377-1429
Mailing Address - Street 1:204 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3328
Mailing Address - Country:US
Mailing Address - Phone:404-377-1429
Mailing Address - Fax:407-377-5644
Practice Address - Street 1:204 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3328
Practice Address - Country:US
Practice Address - Phone:404-377-1429
Practice Address - Fax:404-377-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW000649104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty