Provider Demographics
NPI:1386922722
Name:POSITIVE GROWTH, INC.
Entity type:Organization
Organization Name:POSITIVE GROWTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:VEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-298-9005
Mailing Address - Street 1:3660 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1246
Mailing Address - Country:US
Mailing Address - Phone:404-298-9005
Mailing Address - Fax:404-298-0046
Practice Address - Street 1:3660 MARKET ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1246
Practice Address - Country:US
Practice Address - Phone:404-298-9005
Practice Address - Fax:404-298-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA582299589251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA276791400AMedicaid