Provider Demographics
NPI:1548891393
Name:THE COMFY PLACE LLC
Entity type:Organization
Organization Name:THE COMFY PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:IBEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-265-0184
Mailing Address - Street 1:3001 BRASS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1043
Mailing Address - Country:US
Mailing Address - Phone:470-242-6140
Mailing Address - Fax:
Practice Address - Street 1:182 RILEY AVE STE E2
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-0776
Practice Address - Country:US
Practice Address - Phone:770-265-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006976OtherLCSW