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General NPI Number Information
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NPI Number | 1073788907
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Entity Type | Organization
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Legal Business Name | GENERATIONS MARRIAGE AND FAMILY ENRICHMENT CENTER, LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 344 CORDER RD SUITE A
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City | WARNER ROBINS
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State | GA
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Zip | 31088-3643
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Country | US
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Telephone | 478-922-0751
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Fax | 478-922-7059
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Provider Business Mailing Address
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Address Line | PO BOX 10001
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City | WARNER ROBINS
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State | GA
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Zip | 31095-5001
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Country | US
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Telephone | 478-922-0751
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Fax | 478-922-7059
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. PAULA DAY JOHNS
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Credential | LMFT
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Telephone | 478-922-0751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 726
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License Number State | GA
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