Organization
AMERISOUTH COMMUNITY PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAY PITTMAN (ADMINISTRATOR)
(678) 777-2522
Entity
Organization
Contact information
Practice address
1770 INDIAN TRAIL LILBURN RD, 200, NORCROSS, GA 30093-2642
(678) 777-2522
(404) 496-6845
Mailing address
PO BOX 870167, STONE MOUNTAIN, GA 30087-0005
(678) 777-2522
(404) 496-6845
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
01/14/2010
Last updated
05/25/2011
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