Provider Demographics
NPI:1881968584
Name:GREENLEE BEHAVIORAL HEALTH SERVICES, LLC.
Entity type:Organization
Organization Name:GREENLEE BEHAVIORAL HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:404-298-1230
Mailing Address - Street 1:778 RAYS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3107
Mailing Address - Country:US
Mailing Address - Phone:404-298-1230
Mailing Address - Fax:
Practice Address - Street 1:778 RAYS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3107
Practice Address - Country:US
Practice Address - Phone:404-298-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA453088947A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health