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General NPI Number Information
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NPI Number | 1164358289
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Entity Type | Organization
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Legal Business Name | IMAGO DEI THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 325 HATCHER POINT RD
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City | WAYCROSS
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State | GA
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Zip | 31503-7959
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Country | US
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Telephone | 912-286-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 363 JOYCE RD
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City | WAYCROSS
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State | GA
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Zip | 31503-2901
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Country | US
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Telephone | 912-286-3737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA A FOY
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Credential |
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Telephone | 912-286-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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