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
217 STOCKBRIDGE RD, JONESBORO, GA 30236-3628
(770) 471-4617
(770) 471-7817
Mailing address
157 SMITH ST, JONESBORO, GA 30236-3546
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00395458A
—
GA
05
—
00604205G
—
GA
Enumeration date
10/05/2007
Last updated
11/15/2011
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