Provider Demographics
NPI:1093562480
Name:CEED COMMUNITY ENRICHMENT, LLC
Entity type:Organization
Organization Name:CEED COMMUNITY ENRICHMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNTAVIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-408-0109
Mailing Address - Street 1:228 E POPLAR ST STE C
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-3401
Mailing Address - Country:US
Mailing Address - Phone:678-408-0109
Mailing Address - Fax:
Practice Address - Street 1:228 E POPLAR ST STE C
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3401
Practice Address - Country:US
Practice Address - Phone:678-408-0109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)