Organization
CASE SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN B LEWIS (LICENSED PROFESSIONAL COUNSELOR)
(484) 459-6813
Entity
Organization
Contact information
Practice address
4272 SUBLIME TRL, ATLANTA, GA 30349-8883
(484) 459-6813
Mailing address
2396 PENDERGRASS LN, ELLENWOOD, GA 30294-6249
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC007441
GA
261QM0850X
Adult Mental Health Clinic/Center
LPC007441
GA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
LPC007441
GA
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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