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General NPI Number Information
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NPI Number | 1326428467
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Entity Type | Organization
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Legal Business Name | PAUL ANDERSON FAMILY STRONG CENTER, INC.
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 104 E 2ND ST
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City | VIDALIA
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State | GA
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Zip | 30474-4709
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Country | US
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Telephone | 912-537-7237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1126
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City | VIDALIA
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State | GA
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Zip | 30475-1126
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Country | US
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Telephone | 912-537-7237
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DREW S. READ
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Credential |
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Telephone | 912-537-7237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC006920
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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