Organization
SEEDGROW BEHAVIORAL SERVICES,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE KNOX BCBA (EXECUTIVE DIRECTOR)
(404) 565-6029
Entity
Organization
Contact information
Practice address
505 HEATHERDOWN WAY, RIVERDALE, GA 30274-3592
(678) 435-9214
Mailing address
505 HEATHERDOWN WAY, RIVERDALE, GA 30274-3592
(678) 435-9214
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
01-14-17610
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13604699
CAQH
GA
01
—
1497116834
NPI
GA
Enumeration date
04/02/2016
Last updated
04/02/2016
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