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General NPI Number Information
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NPI Number | 1669847760
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Entity Type | Organization
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Legal Business Name | TIFTAREA PSYCHIATRIC AND COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 223 2ND ST E SUITE B
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City | TIFTON
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State | GA
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Zip | 31794-4493
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Country | US
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Telephone | 229-339-3721
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Fax | 229-472-9151
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Provider Business Mailing Address
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Address Line | PO BOX 1613
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City | TIFTON
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State | GA
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Zip | 31793-1613
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Country | US
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Telephone | 229-339-3721
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Fax | 229-472-9151
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MRS. ANGEANETTE NIXON
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Credential | LPC
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Telephone | 229-339-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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