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General NPI Number Information
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NPI Number | 1568761385
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Entity Type | Organization
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Legal Business Name | FAMILY LIFE COUNSELING CENTER, INC
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 323 PINE AVE STE 102
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City | ALBANY
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State | GA
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Zip | 31701-2595
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Country | US
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Telephone | 229-403-0271
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Fax | 844-464-0611
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Provider Business Mailing Address
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Address Line | 323 PINE AVE STE 102
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City | ALBANY
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State | GA
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Zip | 31701-2595
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Country | US
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Telephone | 229-403-0271
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Fax | 844-464-0611
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLEN KAY WOMACK
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Credential | PSY.D.
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Telephone | 229-403-0271
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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 | PSY1902
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License Number State | GA
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