NPIMap

Organization Active NPI

Cobb Douglas Community Services Board

  • Clinical Social Worker
  • Marietta, GA
National Provider Identifier
1518405752
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW002215 Issued in GA
Legal business name
COBB DOUGLAS COMMUNITY SERVICES BOARD
Practice address
331 N Marietta Pkwy NE
Marietta, GA 30060-1457
Phone
(770) 499-2422
NPI assigned
Feb 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Authorized official

Name
Bryan Stephens, LPC
Title
Interim Ceo
Phone
(770) 429-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X CSW002215 GA Primary

Addresses

Primary practice location

331 N Marietta Pkwy NE
Marietta, GA 30060-1457

Mailing address

331 N Marietta Pkwy NE
Marietta, GA 30060-1457
Phone (770) 499-2422

National Provider Directory

National Provider Directory
Tax ID family
Cobb County Community Services Board13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

331 N Marietta Pkwy NE
Marietta, GA 30060
Phone (770) 499-2422

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1486512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486512000000",
    "number": "1518405752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 N MARIETTA PKWY NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601457",
            "telephone_number": "770-499-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 N MARIETTA PKWY NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601457",
            "telephone_number": "770-499-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBB DOUGLAS COMMUNITY SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-08",
        "last_updated": "2017-02-08",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "770-429-5000",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.