DEKALB COMMUNITY SERVICE BOARD (NPI# 1578608550) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578608550 |
| Entity Type | Organization |
| Organization Name | DEKALB COMMUNITY SERVICE BOARD |
| Other Organization Name | CROSSROADS PEER & SUPPORTED EMPLOYMENT |
| Practice Address |
23 Warren St Se Atlanta GA 30317-2201 |
| Mailing Address |
445 Winn Way Fl 4 Decatur GA 30030-1707 |
| Practice Telephone | 4043707474 |
| Practice Fax Number | 4043707475 |
| Mailing Telephone | 4042943836 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-04-21 |
| Authorized Official Name | FABIO BRUNO VAN DER MERWE (COO) |
| Authorized Official Telephone | 4042943836 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEKALB COMMUNITY SERVICE BOARD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| Crossroads Peer & Supported Employment | Other Name - Individual/Organization |
| Kirkwood Mental Health Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750426755 | Dekalb Community Service Board | Community/Behavioral Health | 2129 Luray Ct, Dunwoody, GA 30338-5212 | 2007-02-20 |
| 1548304637 | Dekalb Community Service Board | Community/Behavioral Health | 4781 Lewis Rd, Stone Mountain, GA 30083-1020 | 2007-02-20 |
| 1932244993 | Dekalb Community Service Board | Community/Behavioral Health | 1116 Alford Rd, Lithonia, GA 30058-6094 | 2007-02-20 |
| 1154466142 | Dekalb Community Service Board | Community/Behavioral Health | 3571 Embry Cir, Chamblee, GA 30341-5613 | 2007-02-20 |
| 1629113436 | Dekalb Community Service Board | Community/Behavioral Health | 4559 Lavista Rd, Tucker, GA 30084-4225 | 2007-02-20 |
| 1497890214 | Dekalb Community Service Board | Community/Behavioral Health | 4200 Waterloo Cir, Tucker, GA 30084-2237 | 2007-02-20 |
| 1861536955 | Dekalb Community Service Board | Community/Behavioral Health | 2660 Osborne Rd Ne, Atlanta, GA 30319-2832 | 2007-02-20 |
| 1003951088 | Dekalb Community Service Board | Community/Behavioral Health | 4316 Smithsonia Dr, Tucker, GA 30084-2615 | 2007-02-20 |
| 1427193226 | Dekalb Community Service Board | Community/Behavioral Health | 1536 Saint Dunstans Rd, Lithonia, GA 30058-5632 | 2007-02-20 |
| 1528103512 | Dekalb Community Service Board | Community/Behavioral Health | 3807 Clairmont Road Ne, Chamblee, GA 30341 | 2007-02-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | DEKALB COMMUNITY SERVICE BOARD | 445 Winn Way, Decatur, GA 30030-1707 |
| Street Address |
23 WARREN ST SE |
| City | ATLANTA |
| State | GA |
| Zip Code | 30317-2201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871661702 | Lee A Cohen | Social Worker | 23 Warren St Se, Atlanta, GA 30317-2201 | 2006-11-30 |
| 1023419181 | Genoa Healthcare, LLC | Pharmacy | 23 Warren St Se, Atlanta, GA 30317-2201 | 2014-09-09 |
| 1992105589 | Genoa Healthcare, LLC | Pharmacy | 23 Warren St Se, Atlanta, GA 30317-2201 | 2014-09-02 |
| 1467880211 | Rachel Weissman | Social Worker | 23 Warren St Se, Atlanta, GA 30317-2201 | 2013-10-14 |
| 1518275114 | David Crow | Social Worker | 23 Warren St Se, Atlanta, GA 30317-2201 | 2010-09-16 |
| 1336364751 | Kathryn B. Houman | Counselor | 23 Warren St Se, Atlanta, GA 30317-2201 | 2007-04-13 |
| 1659493724 | Earnestine B Gray | Registered Nurse | 23 Warren St Se, Atlanta, GA 30317-2201 | 2007-04-06 |
| 1285759688 | Dekalb Community Service Board | Community/Behavioral Health | 23 Warren St Se, Atlanta, GA 30317-2201 | 2007-03-21 |
| 1316078975 | Anthony Leon Nealy | Psychiatry & Neurology | 23 Warren St Se, Atlanta, GA 30317-2201 | 2007-03-07 |
| 1295864783 | Jessie L Mayfield-gathany | Social Worker | 23 Warren St Se, Atlanta, GA 30317-2201 | 2007-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391395 | Tara Lozano Thrutchley | Counselor | 2033 Hosea L Williams Drive Ne, Suite 2, Atlanta, GA 30317 | 2019-11-26 |
| 1689052326 | Pharmworks Group LLC | Pharmacy | 1860 Memorial Dr Se, Atlanta, GA 30317 | 2015-05-14 |
| 1891032157 | Carla Bernita Jones | Licensed Practical Nurse | 2064 Ridgedale Rd Ne, Atlanta, GA 30317 | 2013-01-07 |
| 1154428985 | Dekalb County Board of Health | Public Health or Welfare | 2006 Hosea Williams Dr., Atlanta, GA 30317 | 2006-09-20 |
| 1548228034 | Yuri Okuizumi Wu | Pediatrics | 35 Whitefoord Ave Se, Atlanta, GA 30317 | 2006-05-03 |
| 1093052359 | Third Day Ministry | Religious Nonmedical Practitioner | 2064 Ridgedale Rd Ne, Atlanta, GA 30317 | 2013-01-07 |
| 1548215254 | Adrian Gendell Bonser | Dentist | 30 Warren St, Atlanta, GA 30317 | 2006-05-23 |
| 1245284041 | Magdy Attia | Dentist | 30 Warren St, Atlanta, GA 30317 | 2006-05-19 |
| 1245845288 | Jennie Gray Mulligan | Social Worker | 1911 Hallman St Ne, Atlanta, GA 30317-1001 | 2020-09-15 |
| 1942837125 | Kathryn Caracappa Boulet | Counselor | 1942 Delano Dr Ne, Atlanta, GA 30317-1009 | 2020-03-26 |
| Find all providers in zip 30317 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952914632 | Brighter Dayz, Incorporated | Community/Behavioral Health | 1016 Howell Mill Rd Nw Apt 4408, Atlanta, GA 30318-5592 | 2020-08-24 |
| 1699387688 | Rise Rehabilitation Services, LLC | Community/Behavioral Health | 738 Highland Park Trl, Atlanta, GA 30350-6706 | 2020-08-20 |
| 1700427820 | Trust2change, LLC. | Community/Behavioral Health | 2900 Chamblee Tucker Rd Bldg 8, Atlanta, GA 30341-4100 | 2019-09-30 |
| 1538712088 | Ferris Healthcare Group | Community/Behavioral Health | 2900 Paces Ferry Rd Se Bldg C, Atlanta, GA 30339-5702 | 2019-07-23 |
| 1245890987 | Soc Integrated Services, LLC | Community/Behavioral Health | 130 Wynfield Way Sw, Atlanta, GA 30331-6837 | 2019-06-15 |
| 1770046740 | Z-one Incorporated | Community/Behavioral Health | 505 Tufton Trl Se, Atlanta, GA 30354-2867 | 2019-04-08 |
| 1003377086 | Chris 180, Inc. | Community/Behavioral Health | 3700 Martin Luther King Dr Sw, Atlanta, GA 30331-3674 | 2019-03-30 |
| 1144790783 | Danielle Smith | Community/Behavioral Health | 880 Glenwood Ave Se Unit 3185, Atlanta, GA 30316-1955 | 2018-11-27 |
| 1073083762 | Michael Pollock | Community/Behavioral Health | 3725 Princeton Lakes Pkwy Sw Apt 7003, Atlanta, GA 30331-5560 | 2018-11-26 |
| 1851881353 | Atlanta Life Journeys Services, LLC | Community/Behavioral Health | 3196 Dogwood Dr, Atlanta, GA 30354-1149 | 2018-05-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.