Organization
COMMUNITY BASED HEALTHCARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK BOSWELL JR. BS PSYCHOLOGY (DIRECTOR)
(678) 964-7107
Entity
Organization
Contact information
Practice address
2374 MAIN ST STE B, TUCKER, GA 30084-4533
(678) 964-7107
Mailing address
2374 MAIN ST STE B, TUCKER, GA 30084-4533
(678) 964-7107
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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