Provider Demographics
NPI:1194146266
Name:HIGHLAND RIVERS CSB
Entity type:Organization
Organization Name:HIGHLAND RIVERS CSB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANSLEY
Authorized Official - Middle Name:DEKLE
Authorized Official - Last Name:SILVERS
Authorized Official - Suffix:
Authorized Official - Credentials:CAC II, CCS
Authorized Official - Phone:706-291-7201
Mailing Address - Street 1:6 MATHIS DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1242
Mailing Address - Country:US
Mailing Address - Phone:706-291-7201
Mailing Address - Fax:706-291-7198
Practice Address - Street 1:6 MATHIS DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1242
Practice Address - Country:US
Practice Address - Phone:706-291-7201
Practice Address - Fax:706-291-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1014A0400X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health