Healthcare Provider Details

I. General information

NPI: 1538202502
Provider Name (Legal Business Name): NEW HORIZONS CSB PHOENIX CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9067 VETERANS PKWY
MIDLAND GA
31820-3411
US

IV. Provider business mailing address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-7074
  • Fax: 706-324-7073
Mailing address:
  • Phone: 706-596-5583
  • Fax: 706-596-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PERRY ALEXANDER
Title or Position: CEO
Credential:
Phone: 706-596-5582