Provider Demographics
NPI:1801012398
Name:THE CHILDREN AND TEENAGERS FOUNDATION
Entity type:Organization
Organization Name:THE CHILDREN AND TEENAGERS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BESTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-299-2087
Mailing Address - Street 1:4151 MEMORIAL DR
Mailing Address - Street 2:SUITE 204-A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1504
Mailing Address - Country:US
Mailing Address - Phone:404-299-2087
Mailing Address - Fax:404-299-3564
Practice Address - Street 1:4151 MEMORIAL DR
Practice Address - Street 2:SUITE 204-A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1504
Practice Address - Country:US
Practice Address - Phone:404-299-2087
Practice Address - Fax:404-299-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00134945251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health