MEDICARE: FAUBION THERAPY CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC006470	GA

General Provider Information

NPI Number	:	1700249810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAUBION THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	105 GOVERNORS SQ
Second Line	:	SUITE E
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4866
Country	:	US
Telephone Number	:	678-925-3306
Fax Number	:	678-985-4855

Provider Business Practice Location Address
First Line	:	105 GOVERNORS SQ
Second Line	:	SUITE E
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4866
Country	:	US
Telephone Number	:	678-925-3306
Fax Number	:	678-985-4855

Authorized Official
Title or Position	:	OWNER
Name	:	ALZIRENE FAUBION
Credential	:
Telephone Number	:	678-925-3306

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	04/05/2016

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