Organization
LEVEL UP COMMUNITY SERVICE PROGRAM LLC
Active
Organization
LEVEL UP COMMUNITY SERVICE PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH E SILLS PHD LCSW (EXECUTIVE DIRECTOR)
(678) 849-0505
Entity
Organization
Contact information
Practice address
6754 GREY ROCK WAY, LITHONIA, GA 30058-3077
(678) 849-0505
Mailing address
PO BOX 784, LITHONIA, GA 30058-0784
(678) 849-0505
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014
2014
GA
Enumeration date
07/06/2022
Last updated
07/06/2022
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