Community Teen Coalition, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

07063025 Issued in GA

Legal business name

COMMUNITY TEEN COALITION, INC

Practice address

6035 Brookside Oak Cir
Norcross, GA 30093-1754

Phone

(404) 931-2911

NPI assigned

Jan 16, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dominic Stokes

Title

Founder/Ceo

Phone

(678) 438-5051

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484524800000",
    "number": "1063958973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 HIGHWAY 74 N",
            "address_2": "SUITE F",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 BROOKSIDE OAK CIR",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300931754",
            "telephone_number": "404-931-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY TEEN COALITION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-16",
        "last_updated": "2017-01-16",
        "status": "A",
        "authorized_official_last_name": "STOKES",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "678-438-5051",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "07063025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.