NPIMap

Organization Active NPI

Dekalb Community Service Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chamblee, GA
National Provider Identifier
1982813309
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
000692 Issued in GA
Legal business name
DEKALB COMMUNITY SERVICE BOARD
Practice address
3807 Clairmont Rd
Chamblee, GA 30341-4911
Phone
(770) 457-5867
NPI assigned
May 22, 2007
Last updated
Apr 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Fabio Bruno Van Der Merwe
Title
Coo
Phone
(404) 294-3836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 000692 GA Primary

Addresses

Primary practice location

3807 Clairmont Rd
Chamblee, GA 30341-4911

Mailing address

445 Winn Way
Decatur, GA 30030-1707
Phone (404) 508-7796

Other names 1

  • North DeKalb Mental Health Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Dekalb Community SVC BD24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1982813309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 WINN WAY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301707",
            "telephone_number": "404-508-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3807 CLAIRMONT RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303414911",
            "telephone_number": "770-457-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB COMMUNITY SERVICE BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "VAN DER MERWE",
        "authorized_official_first_name": "FABIO",
        "authorized_official_middle_name": "BRUNO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "404-294-3836"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "000692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North DeKalb Mental Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "North DeKalb Mental Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chamblee, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.