MCINTOSH TRAIL CSB (NPI# 1689852840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689852840 |
| Entity Type | Organization |
| Organization Name | MCINTOSH TRAIL CSB |
| Other Organization Name | FAYETTE CO COUNSELING CENTER |
| Practice Address |
715 Bradley Dr Fayetteville GA 30214-2030 |
| Mailing Address |
1435 N Expressway Suite 301 Griffin GA 30223-9016 |
| Practice Telephone | 7704602460 |
| Mailing Telephone | 7703588250 |
| Mailing Fax Number | 7702293223 |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2015-12-17 |
| Authorized Official Name | MIKE HUBBARD (CEO) |
| Authorized Official Telephone | 7703588251 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000601609M | 05 |
| Other Name | Type Code |
|---|---|
| Fayette Co Counseling Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811165483 | Mcintosh Trail Csb | Community/Behavioral Health | 1209 Greenbelt Dr, Griffin, GA 30224-4507 | 2008-02-15 |
| 1265600100 | Mcintosh Trail Csb | Community/Behavioral Health | 713 Andrews Dr, Thomaston, GA 30286-4524 | 2008-02-13 |
| 1174791016 | Mcintosh Trail Csb | Community/Behavioral Health | 514 W Poplar St, Griffin, GA 30224-2816 | 2008-02-13 |
| 1205004140 | Mcintosh Trail Csb | Community/Behavioral Health | 1343 W Poplar St, Griffin, GA 30224-2130 | 2008-02-13 |
| 1194993030 | Mcintosh Trail Csb | Community/Behavioral Health | 415 Ernest Biles Dr, Jackson, GA 30233-2282 | 2008-02-13 |
| 1801064746 | Mcintosh Trail Csb | Community/Behavioral Health | 672 Industrial Blvd, Mcdonough, GA 30253-6611 | 2008-02-13 |
| 1477721397 | Mcintosh Trail Csb | Community/Behavioral Health | 1459 Williamson Road, Griffin, GA 30224-8428 | 2008-02-13 |
| 1841478013 | Mcintosh Trail Csb | Community/Behavioral Health | 101 Owens Ln, Po Box E, Barnesville, GA 30204-1438 | 2008-02-09 |
| 1023296282 | Mcintosh Trail Csb | Community/Behavioral Health | 318 Burg Rd, Jenkinsburg, GA 30234-2001 | 2008-02-08 |
| 1750569919 | Mcintosh Trail Csb | Community/Behavioral Health | 160 Carnegie Pl, Fayetteville, GA 30214-3905 | 2008-02-08 |
| Street Address |
715 BRADLEY DR |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-2030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912525106 | Charlotte Day Mckenzie | Counselor | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2020-07-14 |
| 1336775626 | Evelyn Cowan Strozier | Counselor | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2020-03-18 |
| 1497310650 | Adrienne Dewberry | Licensed Practical Nurse | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2019-05-03 |
| 1902340250 | Temeka Weatherly | Counselor | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2016-12-06 |
| 1669837969 | Tracy Ann Carmichael | Counselor | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2015-12-31 |
| 1184904211 | Iris Branch Cleveland | Social Worker | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2011-08-21 |
| 1417277997 | Ana Maria Cuebas | Psychiatry & Neurology | 715 Bradley Dr, Fayetteville, GA 30214-2030 | 2010-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528696796 | Faith Springs Eternal (fase), Pllc | Community/Behavioral Health | 2537 Gray Goose Loop, Fayetteville, NC 28306-3550 | 2020-04-01 |
| 1134684392 | Carolina Outreach, LLC | Community/Behavioral Health | 324 Person St, Fayetteville, NC 28301-5736 | 2019-02-01 |
| 1124591094 | Changing Places Therapeutic Center, Company | Community/Behavioral Health | 1044 Bragg Blvd Ste B, Fayetteville, NC 28301-4512 | 2019-01-03 |
| 1538632518 | Benevolent Counseling, Pllc | Community/Behavioral Health | 2929 Breezewood Ave Ste 203, Fayetteville, NC 28303-5357 | 2019-01-02 |
| 1386128031 | Alexander Youth Network | Community/Behavioral Health | 2115 Hope Mills Rd, Fayetteville, NC 28304-4256 | 2018-09-19 |
| 1811497639 | Alexander Youth Network | Community/Behavioral Health | 1608 Camden Rd, Rooms #16 & #17, Fayetteville, NC 28306-1734 | 2018-02-19 |
| 1629578851 | Jeanette Bostick | Community/Behavioral Health | 1628 Turkey Run, Fayetteville, NC 28312-7643 | 2018-02-14 |
| 1942718325 | A Mother's Pursuit, LLC | Community/Behavioral Health | 511 N Reilly Rd Ste A, Fayetteville, NC 28303-2440 | 2018-01-18 |
| 1992213771 | Deborah A Atkinson Phd Pllc | Community/Behavioral Health | 501 Executive Pl Ste B, Fayetteville, NC 28305-5391 | 2018-01-16 |
| 1841739455 | Aci Support Specialists | Community/Behavioral Health | 414 Snowhill Rd, Fayetteville, NC 28306-9073 | 2017-02-15 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on MCINTOSH TRAIL CSB.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.