Provider Demographics
NPI:1023431210
Name:ACCESS MENTAL HEALTH AGENCY
Entity type:Organization
Organization Name:ACCESS MENTAL HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-335-9010
Mailing Address - Street 1:215 LAKEWOOD WAY SW
Mailing Address - Street 2:205
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-6022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 LAKEWOOD WAY SW
Practice Address - Street 2:205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-6022
Practice Address - Country:US
Practice Address - Phone:678-335-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005397101YP2500X
GA006044101YP2500X
GA006188101YP2500X
GA006400101YP2500X
GA006760101YP2500X
GA006205101YP2500X
GA046882103TP0016X
GA10576464103TP0016X
GA005536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty