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General NPI Number Information
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NPI Number | 1972121606
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Entity Type | Organization
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Legal Business Name | INFANT AND EARLY CHILDHOOD MENTAL HEALTH OF GEORGIA
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 260 PLEASANT HILL CHURCH RD SE
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City | WINDER
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State | GA
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Zip | 30680-4255
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Country | US
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Telephone | 706-438-2951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48366
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City | ATHENS
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State | GA
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Zip | 30604-8366
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Country | US
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Telephone | 706-438-2951
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Fax | 706-608-9044
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRASIE A TOPPLE
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Credential | PHD, LCSW
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Telephone | 706-438-2951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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