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General NPI Number Information
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NPI Number | 1467544114
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY GUIDANCE OF GEORGIA, INC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 3033 N COLUMBIA ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-8799
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Country | US
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Telephone | 478-451-5205
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 673
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City | MILLEDGEVILLE
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State | GA
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Zip | 31059-0673
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Country | US
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Telephone | 478-451-5205
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ELIZABETH TRACEY WOOD
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Credential | LPC
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Telephone | 478-451-5205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 581821106
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License Number State | GA
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