Provider Demographics
NPI:1861548190
Name:CENTER FOR BEHAVIORAL CHANGE PC
Entity type:Organization
Organization Name:CENTER FOR BEHAVIORAL CHANGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-292-8388
Mailing Address - Street 1:4151 MEMORIAL DR
Mailing Address - Street 2:SUITE 107E
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1504
Mailing Address - Country:US
Mailing Address - Phone:404-292-8388
Mailing Address - Fax:
Practice Address - Street 1:4151 MEMORIAL DR
Practice Address - Street 2:SUITE 107E
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1504
Practice Address - Country:US
Practice Address - Phone:404-292-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty