Provider Demographics
NPI:1518752161
Name:IMPACT COMMUNITY SERVICES OF GEORGIA LLC
Entity type:Organization
Organization Name:IMPACT COMMUNITY SERVICES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-396-8681
Mailing Address - Street 1:13300 MORRIS RD UNIT 50
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6132
Mailing Address - Country:US
Mailing Address - Phone:404-396-8681
Mailing Address - Fax:
Practice Address - Street 1:13300 MORRIS RD UNIT 50
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6132
Practice Address - Country:US
Practice Address - Phone:404-396-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty