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General NPI Number Information
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NPI Number | 1992380836
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Entity Type | Organization
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Legal Business Name | ARC HOUSE OF ELAVATION
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 1102 E JACKSON ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-4786
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Country | US
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Telephone | 229-403-7047
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Fax | 229-289-1869
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Provider Business Mailing Address
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Address Line | 1102 E JACKSON ST STE 4
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City | THOMASVILLE
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State | GA
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Zip | 31792-4779
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Country | US
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Telephone | 229-403-7047
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ARDRIA L CLARK
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Credential | LPC
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Telephone | 229-403-7047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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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 |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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