| Positive Impact Residential Services | |
|
2189 W Ponce De Leon Ave Decatur GA 30030-2334 | |
| (678) 887-3263 | |
| (404) 687-9871 |
| Full Name | Positive Impact Residential Services |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2189 W Ponce De Leon Ave, Decatur, Georgia |
| Authorized Official Name and Position | Wax Flowers (LCSW/OWNER) |
| Authorized Official Contact | 8667307604 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Impact Residential Services 2189 W Ponce De Leon Ave Decatur GA 30030-2334 Ph: (678) 887-3263 | Positive Impact Residential Services 2189 W Ponce De Leon Ave Decatur GA 30030-2334 Ph: (678) 887-3263 |
| NPI Number | 1487079562 |
|---|---|
| Provider Enumeration Date | 02/25/2014 |
| Last Update Date | 02/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487079562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | CSW002378 (Georgia) | Primary |
Joseph T Elder, Psy.d., P.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1439 Mclendon Dr Ste D, Decatur, GA 30033 Phone: 404-493-4381 Fax: 770-934-3280 | |
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