=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780782128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CALM CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 01/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 GREEN VIEW RD SW
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30165-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-235-1400
-----------------------------------------------------
Fax | 706-510-1357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5072
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30162-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-235-1400
-----------------------------------------------------
Fax | 706-378-8843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DENNETT HOWE GORDON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 706-235-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 003017
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------