Provider Demographics
NPI:1861931172
Name:GEORGIA BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:GEORGIA BEHAVIORAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II, SAP
Authorized Official - Phone:478-352-0422
Mailing Address - Street 1:104 BORDERS WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8967
Mailing Address - Country:US
Mailing Address - Phone:910-689-5190
Mailing Address - Fax:
Practice Address - Street 1:104 BORDERS WAY STE 500
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8967
Practice Address - Country:US
Practice Address - Phone:478-352-0422
Practice Address - Fax:888-813-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1083101YA0400X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty