Organization
BEHAVIORAL HEALTH CRISIS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEFANIE JACKSON CFO (CFO)
(229) 671-6140
Entity
Organization
Contact information
Practice address
3116 NORTH OAK STREET EXT, VALDOSTA, GA 31602-5910
(229) 671-6100
(229) 671-6774
Mailing address
3120 N OAK STREET EXT STE C, VALDOSTA, GA 31602-5910
(229) 671-6100
(229) 671-6774
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000601246A
—
GA
Enumeration date
11/12/2013
Last updated
11/18/2013
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