OrganizationActive
Innovative Consulting Services
NPI 1619115391 · Early Intervention Provider Agency · Covington, GA
Provider details
- NPI number
- 1619115391
- Entity type
- Organization
- Primary specialty
- Early Intervention Provider AgencyAgencies
- Organization subpart
- No
- Authorized official
- Ardena Johnson, Chief Executive Officer(678) 467-2778
Specialties & taxonomies
Agencies
Practice location
60 Lightwood Drive
Covington, GA 30016
Phone: (678) 342-7037
Fax: (678) 342-9632
Approximate (ZIP-level) locationGet directions
Mailing address
60 Lightwood Drive
Covington, GA 30016
Registry dates
- Enumerated
- 2009-02-03
- Last updated
- 2009-02-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.