Organization
PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC
Active
Organization
PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC
Active
Other names
PROPS
Organization subpart
No
Provider details
NPI number
Authorized official
FELICIA BERRY-MITCHELL PHD (PRESIDENT)
(770) 577-7873
Entity
Organization
Contact information
Practice address
6576 CHURCH ST, DOUGLASVILLE, GA 30134-1884
(770) 577-7873
(770) 577-7871
Mailing address
6576 CHURCH ST, DOUGLASVILLE, GA 30134-1884
(770) 577-7873
(770) 577-7871
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PSY003237
GA
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
133N00000X
Nutritionist
—
—
136A00000X
Registered Dietetic Technician
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
171100000X
Acupuncturist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2084P0800X
Psychiatry Physician
—
—
374700000X
Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003132073B
—
GA
Enumeration date
04/17/2014
Last updated
04/17/2014
Update your record
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