ANTIOCH CHRISTIAN CENTER, INC — NPI 1730862954 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1730862954

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1041C0700X (CMS 80)

Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical

Box 32 Service Location & ZIP+4

2879 HERITAGE OAKS CIR, DACULA, GA, 30019-7082

✓ 9-Digit EDI 837 ZIP+4 (30019-7082)

Practice Phone & Referral Fax

(313) 805-5386

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1730862954 (ANTIOCH CHRISTIAN CENTER, INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1730862954` (NPI-2 Organization / Facility)
Provider / Legal Name	ANTIOCH CHRISTIAN CENTER, INC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: `1041C0700X` (Social Worker, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2879 HERITAGE OAKS CIR, DACULA, GA, 30019-7082
Practice Telephone / Fax	Tel: (313) 805-5386
Administrative Mailing Address	2879 HERITAGE OAKS CIR, DACULA, GA, 30019-7082
Enumeration & Last Sync	Enumerated: 2023-08-14 \| CMS Record Updated: 2023-08-14
Authorized Official	PAMELA RICHARDSON (Administrator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2879 HERITAGE OAKS CIR, DACULA, GA, 30019-7082

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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)

What Does Taxonomy Code 1041C0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 80 (Licensed Clinical Social Worker)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANTIOCH CHRISTIAN CENTER, INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`172A00000X` — Driver Plain English: Licensed & Credentialed Driver	State: N/A \| License: `Verified` \| Primary: Secondary
`172V00000X` — Community Health Worker Plain English: Licensed & Credentialed Community Health Worker	State: N/A \| License: `Verified` \| Primary: Secondary
`174H00000X` — Health Educator Plain English: Certified Health Education Specialist (CHES / Preventive Patient Education)	State: N/A \| License: `Verified` \| Primary: Secondary
`101Y00000X` — Counselor Plain English: Licensed & Credentialed Counselor	State: N/A \| License: `Verified` \| Primary: Secondary
`101YA0400X` — Counselor, Addiction (Substance Use Disorder) Plain English: Licensed & Credentialed Counselor, Addiction (Substance Use Disorder)	State: N/A \| License: `Verified` \| Primary: Secondary
`101YM0800X` — Counselor, Mental Health Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Secondary
`101YP1600X` — Counselor, Pastoral Plain English: Licensed & Credentialed Counselor, Pastoral	State: N/A \| License: `Verified` \| Primary: Secondary
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Secondary
`104100000X` — Social Worker Plain English: Licensed & Credentialed Social Worker	State: N/A \| License: `Verified` \| Primary: Secondary
`106H00000X` — Marriage & Family Therapist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Marriage and Family Therapist	State: N/A \| License: `Verified` \| Primary: Secondary
`171M00000X` — Case Manager/Care Coordinator Plain English: Licensed & Credentialed Case Manager/Care Coordinator	State: N/A \| License: `Verified` \| Primary: Secondary
`171W00000X` — Contractor Plain English: Licensed & Credentialed Contractor	State: N/A \| License: `Verified` \| Primary: Secondary
`103T00000X` — Psychologist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist	State: N/A \| License: `Verified` \| Primary: Secondary
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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ANTIOCH CHRISTIAN CENTER, INC (NPI #1730862954)