Organization
CLAYTON MHDDAD
Active
Parent organization
CLAYTON MHDDAD
Other names
Clayton CSB
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLAYTON MHDDAD
Authorized official
MR. TERRY COLE (EXECUTIVE DIRECTOR)
(770) 478-2280
Entity
Organization
Contact information
Practice address
157 SMITH ST, JONESBORO, GA 30236-3546
(770) 478-2280
(770) 477-9772
Mailing address
157 SMITH ST, JONESBORO, GA 30236-3546
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00586176F
—
GA
05
—
00604205D
—
GA
05
—
00606922B
—
GA
05
—
00626249C
—
GA
05
—
00881218A
—
GA
05
—
00884056A
—
GA
Enumeration date
10/05/2007
Last updated
11/08/2011
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