| Fancy Messy, Llc | |
|
4812 Technology Dr Bldg 1 Augusta GA 30907-3912 | |
| (762) 218-3794 | |
| Not Available |
| Full Name | Fancy Messy, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4812 Technology Dr Bldg 1, Augusta, Georgia |
| Authorized Official Name and Position | Lauren Petro (OWNER) |
| Authorized Official Contact | 5859553655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fancy Messy, Llc 725 Southwick Ave Grovetown GA 30813-4278 Ph: (585) 955-3655 | Fancy Messy, Llc 4812 Technology Dr Bldg 1 Augusta GA 30907-3912 Ph: (762) 218-3794 |
| NPI Number | 1043056047 |
|---|---|
| Provider Enumeration Date | 07/08/2024 |
| Last Update Date | 07/08/2024 |
| Certification Date | 07/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043056047 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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