Organization
POSITIVE IMPACT RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAX FLOWERS (LCSW/OWNER)
(866) 730-7604
Entity
Organization
Contact information
Practice address
2189 W PONCE DE LEON AVE, DECATUR, GA 30030-2334
(678) 887-3263
(404) 687-9871
Mailing address
2189 W PONCE DE LEON AVE, DECATUR, GA 30030-2334
(678) 887-3263
(404) 687-9871
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
CSW002378
GA
Other
Enumeration date
02/25/2014
Last updated
02/25/2014
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