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General NPI Number Information
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NPI Number | 1740538701
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Entity Type | Organization
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Legal Business Name | THERAPY ON THE GO LLC
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Dates
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Enumeration Date | 08/24/2012
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 405 TRAVELERS REST RD
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City | MONTEZUMA
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State | GA
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Zip | 31063-2032
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Country | US
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Telephone | 478-244-0926
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Fax | 478-472-1207
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Provider Business Mailing Address
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Address Line | 405 TRAVELERS REST RD
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City | MONTEZUMA
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State | GA
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Zip | 31063-2032
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Country | US
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Telephone | 478-244-0926
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAWN JAMES
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Credential | LPC
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Telephone | 478-244-0926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | GA
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