Provider Demographics
NPI:1780088195
Name:GLOBECORE, INC.
Entity type:Organization
Organization Name:GLOBECORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-641-7705
Mailing Address - Street 1:2031 PINNACLE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4917
Mailing Address - Country:US
Mailing Address - Phone:404-641-7705
Mailing Address - Fax:770-559-9015
Practice Address - Street 1:3355 LENOX RD NE
Practice Address - Street 2:STE 1000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326
Practice Address - Country:US
Practice Address - Phone:770-284-1044
Practice Address - Fax:404-228-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003785251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148962AMedicaid