Ethel's Place, Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ETHEL'S PLACE, INC.

Doing business as

The Gussie Williams Community Resource Center

Practice address

302 W I Pkwy
Dallas, GA 30132-5061

Phone

(678) 363-3799

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Mr. George Williams

Title

Executive Director

Phone

(678) 858-6283

Specialties & licenses 1

Addresses

Other names 1

• The Gussie Williams Community Resource Center Doing business as

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225253354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W I PKWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301325061",
            "telephone_number": "678-363-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W I PKWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301325061",
            "telephone_number": "678-363-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEL'S PLACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "678-858-6283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Gussie Williams Community Resource Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.