| Organization Name: | PROVIDENCE RESIDENTIAL & OUTPATIENT PTSD SERVICES, LLC |
| NPI Number: | 1215357272 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FELICIA BERRY-MITCHELL (PRESIDENT) |
| Mailing Address: | 6576 Church St Douglasville |
| State: | GA US |
| Postal Code: | 301341884 |
| Phone Number: | 7705777873 |
| Fax Number: | 7705777871 |
| NPI Enumeration Date: | 04/17/2014 |
| NPI Last Update Date: | 04/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |