Provider Demographics
NPI:1114196912
Name:AUSBORN BEHAVIORAL CARE, PC
Entity type:Organization
Organization Name:AUSBORN BEHAVIORAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CHIEF FINANCIAL OFFI
Authorized Official - Prefix:DR
Authorized Official - First Name:DENELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZENBY-AUSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-938-4616
Mailing Address - Street 1:2295 PARKLAKE DRIVE, N.E.
Mailing Address - Street 2:SUITE 545
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2950
Mailing Address - Country:US
Mailing Address - Phone:770-938-4616
Mailing Address - Fax:855-932-4901
Practice Address - Street 1:2295 PARKLAKE DRIVE, N.E.
Practice Address - Street 2:SUITE 545
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2950
Practice Address - Country:US
Practice Address - Phone:770-938-4616
Practice Address - Fax:855-932-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty