Organization
DILLARD ACADEMY
Active
Other names
Dillard Foundation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFF BAKER SC.D (CONSULTANT)
(404) 806-0434
Entity
Organization
Contact information
Practice address
8014 CUMMING HWY, SUITE 403302, CANTON, GA 30115-9339
(404) 806-0434
Mailing address
1602 STEPHENS ST, GOLDSBORO, NC 27530-6720
(919) 738-1206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251300000X
Local Education Agency (LEA)
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8600110
—
NC
Enumeration date
12/05/2013
Last updated
12/05/2013
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