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General NPI Number Information
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NPI Number | 1154772481
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Entity Type | Organization
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Legal Business Name | LAGRANGE FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 102 MAIN ST STE 217
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City | LAGRANGE
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State | GA
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Zip | 30240-3212
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Country | US
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Telephone | 706-594-8174
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Fax |
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Provider Business Mailing Address
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Address Line | 102 MAIN ST STE 217
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City | LAGRANGE
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State | GA
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Zip | 30240-3212
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Country | US
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Telephone | 706-594-8174
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET BROWN
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Credential | LCSW
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Telephone | 706-594-8174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005322
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License Number State | GA
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