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General NPI Number Information
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NPI Number | 1518039346
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Entity Type | Organization
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Legal Business Name | LOOKOUT MOUNTAIN COMMUNITY SERVICES
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/15/2007
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Provider Practice Location Address
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Address Line | 501 MIZE STREET
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City | LA FAYETTE
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State | GA
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Zip | 30728
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Country | US
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Telephone | 706-638-5584
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Fax | 706-638-5585
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Provider Business Mailing Address
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Address Line | PO BOX 1027
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City | LA FAYETTE
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State | GA
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Zip | 30728-1027
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Country | US
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Telephone | 706-638-5584
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Fax | 706-638-5585
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | THOMAS W. FORD
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Credential | PH.D.
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Telephone | 706-638-5584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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