NPIMap

Organization Active NPI

McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Fayetteville, GA
National Provider Identifier
1689852840
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MCINTOSH TRAIL COMMUNITY SERVICE BOARD
Practice address
245 Booker Ave
Suite F
Fayetteville, GA 30215
Phone
(770) 358-5252
Fax
(770) 229-3223
NPI assigned
Feb 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Kenyatta Denise Walker, LCSW
Title
Ceo
Phone
(770) 358-5252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

245 Booker Ave
Suite F
Fayetteville, GA 30215

Mailing address

1435 North Expressway Suite 301
Griffin, GA 30223
Phone (770) 358-5252

Other identifiers 1

IdentifierTypeStateIssuer
000601609MMedicaidGA

Other names 1

  • Fayette Co Counseling Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McIntosh Trail CSB29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

715 Bradley Dr
Fayetteville, GA 30214
Phone (770) 358-8584

245 Booker Ave
Ste F
Fayetteville, GA 30215

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1202428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1689852840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 NORTH EXPRESSWAY SUITE 301",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "30223",
            "telephone_number": "770-358-5252",
            "fax_number": "770-229-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 BOOKER AVE",
            "address_2": "SUITE F",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30215",
            "telephone_number": "770-358-5252",
            "fax_number": "770-229-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCINTOSH TRAIL COMMUNITY SERVICE BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-08",
        "last_updated": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENYATTA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-358-5252",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000601609M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fayette Co Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; 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.