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General NPI Number Information
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NPI Number | 1699941187
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Entity Type | Organization
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Legal Business Name | THOMASVILLE FAMILY COUNSELING CENTER
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 330 N BROAD ST STE B
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City | THOMASVILLE
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State | GA
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Zip | 31792-5100
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Country | US
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Telephone | 229-551-9300
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Fax | 229-226-4649
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Provider Business Mailing Address
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Address Line | PO BOX 1353
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City | THOMASVILLE
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State | GA
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Zip | 31799-1353
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Country | US
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Telephone | 229-551-9300
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Fax | 229-226-4649
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY J BRENGOSZ
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Credential |
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Telephone | 229-551-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY002460
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License Number State | GA
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