Provider Demographics
NPI:1538609888
Name:BEPROACTIVE FOUNDATION, INC
Entity type:Organization
Organization Name:BEPROACTIVE FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RJ
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:770-319-7468
Mailing Address - Street 1:1830 WATER PL SE
Mailing Address - Street 2:STE #220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7407
Mailing Address - Country:US
Mailing Address - Phone:770-319-7468
Mailing Address - Fax:866-416-1767
Practice Address - Street 1:1830 WATER PL SE
Practice Address - Street 2:STE #220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7407
Practice Address - Country:US
Practice Address - Phone:770-319-7468
Practice Address - Fax:866-416-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251V00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable