Organization
DEKALB COMMUNITY SERVICE BOARD
Active
Parent organization
DEKALB COMMUNITY SERVICE BOARD
Other names
East DeKalb, DeKalb Enterprises
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEKALB COMMUNITY SERVICE BOARD
Authorized official
FABIO BRUNO VAN DER MERWE (COO)
(404) 294-3836
Entity
Organization
Contact information
Practice address
4781 LEWIS RD, STONE MOUNTAIN, GA 30083-1020
(770) 270-2710
(770) 270-2714
Mailing address
445 WINN WAY FL 4, DECATUR, GA 30030-1707
(404) 294-3836
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000599519E
—
GA
05
—
000603446J
—
GA
Enumeration date
02/20/2007
Last updated
04/28/2020
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