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General NPI Number Information
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NPI Number | 1396012852
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Entity Type | Organization
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Legal Business Name | SERVICORP RESOURCE CENTER, INC.
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 1904 HIGHLAND AVENUE
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City | AUGUSTA
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State | GA
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Zip | 30904
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Country | US
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Telephone | 706-755-2095
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Fax | 706-755-2095
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Provider Business Mailing Address
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Address Line | 1904 HIGHLAND AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5305
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Country | US
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Telephone | 706-755-2095
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Fax | 706-755-2095
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | MRS. PATRICIA PRICE FRANCIS
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Credential | N/A
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Telephone | 706-755-2095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 020772253
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License Number State | GA
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