Provider Demographics
NPI:1922623644
Name:SKIDAWAY BEHAVIORAL INSTITUTE LLC
Entity type:Organization
Organization Name:SKIDAWAY BEHAVIORAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIRSOL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CAP, NCC,
Authorized Official - Phone:912-372-3700
Mailing Address - Street 1:PO BOX 13643
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0643
Mailing Address - Country:US
Mailing Address - Phone:912-372-3700
Mailing Address - Fax:
Practice Address - Street 1:3 WESTRIDGE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-2951
Practice Address - Country:US
Practice Address - Phone:912-372-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty