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General NPI Number Information
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NPI Number | 1285182303
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Entity Type | Organization
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Legal Business Name | REGENERATION FAMILY ADVOCACY CENTER
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Dates
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Enumeration Date | 09/18/2016
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1285 MARKS CHURCH RD STE F
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City | AUGUSTA
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State | GA
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Zip | 30909-2472
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Country | US
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Telephone | 229-376-9345
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Fax |
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Provider Business Mailing Address
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Address Line | 1997 POWERS FERRY RD SE APT B
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City | MARIETTA
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State | GA
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Zip | 30067-5219
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Country | US
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Telephone | 678-324-8328
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Fax | 678-324-8328
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Authorized Official
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Title or Position | OWNER
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Name | MS. TOSHA JOHNSON
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Credential | MSW
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Telephone | 678-670-8736
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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