Bagley Youth Development

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LPC001132 Issued in GA

Legal business name

BAGLEY YOUTH DEVELOPMENT

Practice address

2245 Godby Rd
Suite 206
College Park, GA 30349-5059

Phone

(404) 968-4662

Fax

(404) 968-4562

NPI assigned

Jan 31, 2007

Last updated

May 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Georgiana Bagley, M.S., LPCNPI 1770720690

Title

Ceo

Phone

(404) 968-4662

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Georgiana Bagley, LPC

  • Professional Counselor
  • Atlanta, GA
  • NPI 1770720690
  NPD (past) Authorized official
• S. Bernard Bagley, LCSW

  • Clinical Social Worker
  • Fayetteville, GA
  • NPI 1023580800
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242691200000",
    "number": "1811034317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 WINDERMERE CIR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652278",
            "telephone_number": "678-362-7802",
            "fax_number": "404-968-4562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2245 GODBY RD",
            "address_2": "SUITE 206",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495059",
            "telephone_number": "404-968-4662",
            "fax_number": "404-968-4562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAGLEY YOUTH DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-05-19",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "GEORGIANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-968-4662",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "LPC001132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503205308A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Teri Ayewoh, LMSW, CAMS-11
• Cynthia Bacon-Whitted, LCSW
• Travis Barber, CLC
• Lisa Michelle Bartell, BACHELOR
• Cerissa Bartlett, LPC
• Michael Clifford Basille, D.C.
• Toni Beasley

• Community/Behavioral Health Agency in College Park, GA
• Providers in College Park, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; 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.