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Organization
CLAYTON MHDDAD
Active
Organization
CLAYTON MHDDAD
Active
Other names
Clayton Center CSB
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY COLE (EXECUTIVE DIRECTOR)
(770) 478-2280
Entity
Organization
Contact information
Practice address
217 STOCKBRIDGE RD, JONESBORO, GA 30236-3628
(770) 478-2280
(770) 477-9772
Mailing address
157 SMITH ST, JONESBORO, GA 30236-3546
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
104100000X
Social Worker
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000604205D
—
GA
Enumeration date
08/05/2008
Last updated
11/15/2011
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