Provider Demographics
NPI:1720509235
Name:CHAMPION BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:CHAMPION BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-545-1239
Mailing Address - Street 1:3171 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2361
Mailing Address - Country:US
Mailing Address - Phone:404-804-0985
Mailing Address - Fax:404-393-7245
Practice Address - Street 1:3171 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2361
Practice Address - Country:US
Practice Address - Phone:404-804-0985
Practice Address - Fax:404-393-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007634101YM0800X
GALPC007348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty