Organization
BHI OUTLET INC
Active
Other names
Blakes House of Independence
Organization subpart
No
Provider details
NPI number
Authorized official
JAMITA MARTIN (CEO)
(770) 634-9994
Entity
Organization
Contact information
Practice address
7450 HIGHWAY 92 STE 120, WOODSTOCK, GA 30189-3484
(787) 672-8656
(855) 413-6890
Mailing address
7450 HIGHWAY 92 STE 120, WOODSTOCK, GA 30189-3484
(787) 672-8656
(855) 413-6890
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Enumeration date
08/22/2023
Last updated
08/22/2023
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