# CHRYSALIS, A HOME FOR GIRLS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chrysalis
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891808036
- **Authorized official:** MR. RICHARD DISMUKES LPC (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (334) 793-2237

## Contact information

- **Practice address:** 545 JUDGE LOGUE RD, NEWTON, AL 36352-8607
- **Practice address phone:** (334) 692-5553
- **Practice address fax:** (334) 692-5554
- **Mailing address:** 100 WESTSIDE DR, DOTHAN, AL 36303-1908
- **Mailing address phone:** (334) 793-2237
- **Mailing address fax:** (334) 712-6256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 12901 | AL | Yes |

## Other

- **Enumeration date:** 08/15/2006
- **Last updated:** 08/22/2020