STRAIGHT STREET LIFE CENTER INC (NPI# 1598328791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598328791 |
| Entity Type | Organization |
| Organization Name | STRAIGHT STREET LIFE CENTER INC |
| Practice Address |
12461 Veterans Memorial Douglasville GA 30134 |
| Practice Telephone | 7702254701 |
| Mailing Telephone | 7702254701 |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-04-15 |
| Authorized Official Name | MS. JESSICA L FRAZIER (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4049513969 |
| Authorized Official Credential | BA, CERTIFIED LI |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
12461 VETERANS MEMORIAL |
| City | DOUGLASVILLE |
| State | GA |
| Zip Code | 30134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851915631 | Lilian Pereira | Nurse Practitioner | Bethesda Medical Group, LLC, 9280 Hwy 5 - Suite D, Douglasville, GA 30134 | 2020-06-08 |
| 1548822901 | Sweet Resolve LLC | Nurse Practitioner | 4318 Ridge Rd, Ste 111 Pmb 1017, Douglasville, GA 30134 | 2019-07-05 |
| 1174014930 | Caitlin Waldrip | Chiropractor | 8326a Office Park Dr., Douglasville, GA 30134 | 2018-05-28 |
| 1861901050 | Michelle Denise Winston | Licensed Practical Nurse | 6497 E Strickland, Douglasville, GA 30134 | 2017-09-20 |
| 1518335843 | Willis Anthony Rogers | Durable Medical Equipment & Medical Supplies | 7094 Rose Lake Circle, Douglasville, GA 30134 | 2015-09-03 |
| 1497135131 | Patricia Warren | Social Worker | 8317 Office Park Drive Ste.#e, Douglasville, GA 30134 | 2015-06-08 |
| 1457747321 | Kidz Rock Therapy Services, LLC | Occupational Therapist | 6732 West Spring Street, Douglasville, GA 30134 | 2015-04-08 |
| 1386068476 | Naa Y Oden | Psychologist | 4813 Ridge Rd Ste 111-639, Douglasville, GA 30134 | 2014-02-10 |
| 1467893271 | American Ems | Ambulance | 7240 Bankhead Hwy, Douglasville, GA 30134 | 2013-07-09 |
| 1326381377 | Cheryl A Francis | Counselor | 7061 Skippingstone Way, Douglasville, GA 30134 | 2013-03-28 |
| Find all providers in zip 30134 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760103 | Green Zone Counseling | Peer Specialist | 432 Canton Rd Ste G, Cumming, GA 30040-2000 | 2020-11-02 |
| 1225678386 | John William Burdeshaw | Peer Specialist | 3916 Valley Rd, Columbus, GA 31907-5657 | 2020-01-07 |
| 1851953962 | Jamie Greshawn Hudgens | Peer Specialist | 1734 Ridge Ct Se, Conyers, GA 30013-1726 | 2019-06-28 |
| 1497213748 | Ronald E. Johnson | Peer Specialist | Carl Vinson Va Medical Center, 1826 Veterans Blvd., Dublin, GA 31021 | 2019-03-06 |
| 1669941761 | Paul-david Arthur Cooper | Peer Specialist | 117 Shawnee Street, Va Savannah Clinic, Savannah, GA 31419 | 2018-11-19 |
| 1477069292 | Penny Campbell Foskey | Peer Specialist | 2041 W Elm St, Wrightsville, GA 31096-5156 | 2017-12-15 |
| 1568913945 | Michelle Little | Peer Specialist | 6828 Sarah Jane Ln, Riverdale, GA 30296-2600 | 2016-10-20 |
| 1386195774 | Scott Kerns Jr. | Peer Specialist | 433 Highland Ave Ne, Apt 1156, Atlanta, GA 30312-1391 | 2016-10-20 |
| 1558713479 | Safe Place Atlanta | Peer Specialist | 6612 Pamplona Pl, College Park, GA 30349-8491 | 2016-07-02 |
| 1194196329 | Mary Williams | Peer Specialist | 277 E Big Indian Trl Ne, Rome, GA 30165-7413 | 2015-10-14 |
| Find all providers with the same taxonomy | ||||
| City | DOUGLASVILLE |
| Zip Code | 30134 |
Please comment or provide details below to improve the information on STRAIGHT STREET LIFE CENTER INC.
| 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.